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Question 1
Incorrect
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A 30-year-old woman with treatment-resistant depression has been taking an MAOI without improvement. You plan to switch to an SSRI. What is the recommended waiting period before starting the new medication?
Your Answer: 7 days
Correct Answer: 14 days
Explanation:To avoid a severe drug reaction, it is important to wait at least two weeks after stopping a monoamine oxidase inhibitor (MAOI) before starting a selective serotonin reuptake inhibitor (SSRI). MAOIs can inhibit the enzymes responsible for breaking down certain neurotransmitters, such as noradrenaline and 5-hydroxytryptamine (5HT), as well as tyramine. It may take up to two weeks for these enzymes to resume normal activity after stopping an MAOI, and starting an SSRI during this time can be dangerous.
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This question is part of the following fields:
- Psychopharmacology
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Question 2
Correct
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What is the lowest amount of fluoxetine that can effectively treat adults?
Your Answer: 20 mg
Explanation:Adults require a minimum effective dose of 20 mg of fluoxetine.
Antidepressants: Minimum Effective Doses
According to the Maudsley 13th, the following are the minimum effective doses for various antidepressants:
– Citalopram: 20 mg/day
– Fluoxetine: 20 mg/day
– Fluvoxamine: 50 mg/day
– Paroxetine: 20 mg/day
– Sertraline: 50 mg/day
– Mirtazapine: 30 mg/day
– Venlafaxine: 75 mg/day
– Duloxetine: 60 mg/day
– Agomelatine: 25 mg/day
– Moclobemide: 300 mg/day
– Trazodone: 150 mg/dayNote that these are minimum effective doses and may vary depending on individual factors and response to treatment. It is important to consult with a healthcare professional before starting of changing any medication regimen.
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This question is part of the following fields:
- Psychopharmacology
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Question 3
Correct
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Which area of the cerebellum is responsible for regulating precise and delicate movements of the body?
Your Answer: Spinocerebellum
Explanation:The Cerebellum: Anatomy and Function
The cerebellum is a part of the brain that consists of two hemispheres and a median vermis. It is separated from the cerebral hemispheres by the tentorium cerebelli and connected to the brain stem by the cerebellar peduncles. Anatomically, it is divided into three lobes: the flocculonodular lobe, anterior lobe, and posterior lobe. Functionally, it is divided into three regions: the vestibulocerebellum, spinocerebellum, and cerebrocerebellum.
The vestibulocerebellum, located in the flocculonodular lobe, is responsible for balance and spatial orientation. The spinocerebellum, located in the medial section of the anterior and posterior lobes, is involved in fine-tuned body movements. The cerebrocerebellum, located in the lateral section of the anterior and posterior lobes, is involved in planning movement and the conscious assessment of movement.
Overall, the cerebellum plays a crucial role in motor coordination and control. Its different regions and lobes work together to ensure smooth and precise movements of the body.
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This question is part of the following fields:
- Neurosciences
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Question 4
Incorrect
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Which enzyme is primarily responsible for the metabolism of clozapine?
Your Answer: CYP3A4
Correct Answer: CYP1A2
Explanation:Clozapine is an atypical antipsychotic drug that acts as an antagonist at various receptors, including dopamine, histamine, serotonin, adrenergic, and cholinergic receptors. It is mainly metabolized by CYP1A2, and its plasma levels can be affected by inducers and inhibitors of this enzyme. Clozapine is associated with several side effects, including drowsiness, constipation, weight gain, and hypersalivation. Hypersalivation is a paradoxical side effect, and its mechanism is not fully understood, but it may involve clozapine agonist activity at the muscarinic M4 receptor and antagonist activity at the alpha-2 adrenoceptor. Clozapine is also associated with several potentially dangerous adverse events, including agranulocytosis, myocarditis, seizures, severe orthostatic hypotension, increased mortality in elderly patients with dementia-related psychosis, colitis, pancreatitis, thrombocytopenia, thromboembolism, and insulin resistance and diabetes mellitus. The BNF advises caution in using clozapine in patients with prostatic hypertrophy, susceptibility to angle-closure glaucoma, and adults over 60 years. Valproate should be considered when using high doses of clozapine, plasma levels > 0.5 mg/l, of when the patient experiences seizures. Myocarditis is a rare but potentially fatal adverse event associated with clozapine use, and its diagnosis is based on biomarkers and clinical features. The mortality rate of clozapine-induced myocarditis is high, and subsequent use of clozapine in such cases leads to recurrence of myocarditis in most cases.
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This question is part of the following fields:
- Psychopharmacology
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Question 5
Incorrect
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A 60 year old man with depression is admitted to hospital for an assessment. During the physically examination you notice he has bilaterally small pupils. On further examination you note that they fail to dilate when the lights are turned off and react in a sluggish manner to accommodation. Which of the following do you suspect?
Your Answer: Argyll Robertson pupils
Correct Answer: Senile miosis
Explanation:Senile Pupil: A Common Age-Related Condition
The senile pupil, also known as senile miosis, is a condition commonly observed in older individuals. It is characterized by a small pupil that does not dilate in the dark, and may also be associated with reduced reaction to light and accommodation. This condition is often a result of age-related changes in the muscles that control the pupil, and can be exacerbated by certain medications of medical conditions. While it may not cause significant vision problems, it is important for individuals with senile pupil to have regular eye exams to monitor any changes in their vision and ensure proper eye health.
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This question is part of the following fields:
- Classification And Assessment
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Question 6
Correct
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What study on hepatitis resulted in significant modifications to research ethics laws?
Your Answer: Willowbrook State School study
Explanation:The Willowbrook School Study was conducted in a state-supported institution for children with learning difficulties in New York during the 1960s. The study involved inoculating healthy children with hepatitis and administering gamma globulin to assess its potential to treat the disorder.
The Tuskegee syphilis experiment was a controversial follow-up study of people with syphilis. Many participants were not informed of their illness and did not receive available treatment, even though it became available halfway through the study. The Belmont report introduced changes to US law on research ethics as a result of this study.
The Stanford prison experiment involved creating a simulated prison environment at Stanford University. Participants were assigned as either a prison of a guard and were given no guidelines for how to behave. Within two days, the participants began to act out their assigned roles, with guards becoming harsh and sometimes cruel to the prisoners. The study was terminated after only six days due to extreme emotional reactions from some of the prisoners.
The Tearooms Study involved Humphreys hanging around public toilets where men meet to have sex in order to study the population and learn more about the types of men that did it. The method was controversial as he never disclosed his motives when he interviewed the men and instead pretended to be a ‘watch queen’, raising issues of informed consent in research.
Milgram’s Study investigated authority and obedience. Participants were assigned the role of teacher and administered fake shocks to a confederate playing the learner. Despite expressing concern, 30% of participants continued to administer shocks until 450 volts was reached. The study raised concerns for the wellbeing of participants, but Milgram decided not to terminate it as prior participants seemed to recover relatively well.
Beecher’s Study
Beecher’s study revealed more than 20 instances where individuals were subjected to experimentation without being fully informed of their participation in research and the potential risks involved. One of the cases cited was the Willowbrook State School study, where children with mental disabilities were intentionally infected with hepatitis under the guise of a vaccination program.
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This question is part of the following fields:
- Social Psychology
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Question 7
Correct
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Tim displays odd behavior, such as avoiding stepping on thresholds due to superstition, and provides excessively detailed answers to questions. He strongly believes in UFOs and government contact with them, and his social life revolves around an online community focused on these beliefs. He lives with his mother and has never been in a romantic relationship. His family has expressed concern about his odd behavior and potential for schizophrenia, but he has not exhibited hallucinations like his aunt. Based on these symptoms, what do you suspect Tim has?
Your Answer: Schizotypal PD
Explanation:Schizotypal PD is classified differently in DSM-IV and ICD-10, with the latter listing it under psychotic disorders. It is genetically linked to schizophrenia and often found in first-degree relatives of those with the disorder. In this case, there is no evidence of schizophrenia or schizoaffective disorder, but the individual’s beliefs are outside of cultural norms. The DSM-IV criteria for schizotypal PD include social and interpersonal deficits, cognitive of perceptual distortions, and eccentric behavior. The individual must exhibit at least five of the listed criteria, such as odd beliefs of magical thinking, unusual perceptual experiences, and suspiciousness of paranoid ideation. The disorder cannot be exclusively attributed to another mental health condition.
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This question is part of the following fields:
- Diagnosis
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Question 8
Incorrect
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Which of the following should be avoided when treating akathisia?
Your Answer: Trazodone
Correct Answer: Lamotrigine
Explanation:Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).
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This question is part of the following fields:
- Psychopharmacology
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Question 9
Correct
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What distinguishing characteristics indicate a diagnosis of dissociative non-epileptic attacks (pseudoseizures) instead of generalized tonic-clonic seizures?
Your Answer: Gradual onset of episode
Explanation:The presence of a gradual onset may indicate non-epileptic attacks, while other symptoms suggest genuine generalised tonic clonic seizures. Additional characteristics of pseudoseizures include a higher incidence in females (8:1), a history of previous illness behavior, and childhood physical and/of sexual abuse. Diagnosis can be challenging, but video EEG can be a useful tool in confirming the presence of pseudoseizures.
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This question is part of the following fields:
- Neurosciences
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Question 10
Correct
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What is located within Brodmann area 22?
Your Answer: Wernicke's area
Explanation:Broca’s and Wernicke’s are two types of expressive dysphasia, which is characterized by difficulty producing speech despite intact comprehension. Dysarthria is a type of expressive dysphasia caused by damage to the speech production apparatus, while Broca’s aphasia is caused by damage to the area of the brain responsible for speech production, specifically Broca’s area located in Brodmann areas 44 and 45. On the other hand, Wernicke’s aphasia is a type of receptive of fluent aphasia caused by damage to the comprehension of speech, while the actual production of speech remains normal. Wernicke’s area is located in the posterior part of the superior temporal gyrus in the dominant hemisphere, within Brodmann area 22.
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This question is part of the following fields:
- Neurosciences
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Question 11
Correct
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What is a true statement about Erikson's theory of human development?
Your Answer: It accords with the 'epigenetic principle'
Explanation:Erik Erikson and Daniel Levinson expanded the understanding of adult development. Erikson proposed a life-span model of human development consisting of eight successive psychosocial stages, each associated with an inherent conflict of crisis that the individual must encounter and successfully resolve to proceed with development. Levinson proposed a developmental theory consisting of universal stages of phases that extend from the infancy state to the elderly state, based on biographical interviews of 40 men in America. Both theorists maintained that personality develops in a predetermined order and builds upon each previous stage, and that failure to successfully negotiate a stage can result in a reduced ability to complete further stages and therefore a more unhealthy personality and sense of self. However, Levinson’s theory is age-based rather than event-based, and his model proposed a ‘life sequence’ consisting of a series of alternating stable (structure-building) periods and cross-era transitional (structure-changing) periods, with transitional periods typically lasting 5 years.
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This question is part of the following fields:
- Psychological Development
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Question 12
Correct
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From which region of the developing brain does the retina originate?
Your Answer: Diencephalon
Explanation:The retina and optic nerves originate from protrusions of the diencephalon known as eye vesicles during development.
Neurodevelopment: Understanding Brain Development
The development of the central nervous system begins with the neuroectoderm, a specialized region of ectoderm. The embryonic brain is divided into three areas: the forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The prosencephalon further divides into the telencephalon and diencephalon, while the hindbrain subdivides into the metencephalon and myelencephalon.
The telencephalon, of cerebrum, consists of the cerebral cortex, underlying white matter, and the basal ganglia. The diencephalon includes the prethalamus, thalamus, hypothalamus, subthalamus, epithalamus, and pretectum. The mesencephalon comprises the tectum, tegmentum, ventricular mesocoelia, cerebral peduncles, and several nuclei and fasciculi.
The rhombencephalon includes the medulla, pons, and cerebellum, which can be subdivided into a variable number of transversal swellings called rhombomeres. In humans, eight rhombomeres can be distinguished, from caudal to rostral: Rh7-Rh1 and the isthmus. Rhombomeres Rh7-Rh4 form the myelencephalon, while Rh3-Rh1 form the metencephalon.
Understanding neurodevelopment is crucial in comprehending brain development and its complexities. By studying the different areas of the embryonic brain, we can gain insight into the formation of the central nervous system and its functions.
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This question is part of the following fields:
- Neurosciences
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Question 13
Correct
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What is the most appropriate term to describe the sequence of events that occurred when a man experienced chest pain at work, was taken to the hospital, received blood tests and an ECG, was prescribed medication, and signed off work for a month by a doctor?
Your Answer: Sick role
Explanation:There is no indication of feigning symptoms for personal benefit.
The Sick Role and Illness Behavior
Mechanic and Volkart (1961) introduced the term illness behavior to describe how individuals perceive, evaluate, and respond to symptoms of physical dysfunction. Meanwhile, Talcott Parsons (1951) introduced the concept of the sick role as a temporary form of deviant behavior that is medically sanctioned.
According to Parsons, a sick person experiences conflicting desires to recover from the illness and to enjoy the secondary gains of attention and exemption from normal duties. The sick role is characterized by several rules, including the exemption of the sick person from their normal social roles, which is legitimized by society through the physician. The severity of the illness determines the strength of the exemption.
Additionally, sick persons are not held responsible for their illnesses, as they are beyond personal control. However, they have a duty to try to get well, as sickness is considered undesirable by society. Seeking competent technical help and cooperating with caregivers are also expected of sick persons.
In summary, the sick role and illness behavior are important concepts in understanding how individuals respond to physical dysfunction and how society legitimizes and responds to illness.
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This question is part of the following fields:
- Social Psychology
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Question 14
Correct
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A teenager who is texting while driving almost hits a group of pedestrians. When he stops the car, one of the pedestrians approaches him and yells. The teenager feels ashamed of his behavior and is reminded to be more cautious when driving. What type of operant conditioning is this an example of?
Your Answer: Positive punishment
Explanation:The women’s shouting, which is an unpleasant stimulus, serves as a positive punisher that reduces the likelihood of the behavior (speeding) occurring again. This is distinct from reinforcement, which involves the introduction of a positive stimulus to increase the likelihood of a behavior being repeated.
Operant Conditioning: Reinforcement, Punishment, and More
Operant conditioning, also known as instrumental learning, is a theory of learning developed by B.F. Skinner. It suggests that people learn by interacting with their environment. Reinforcement and punishment are key concepts in operant conditioning. A reinforcer is a stimulus of event that increases the likelihood of a behavior being repeated. Reinforcement can be positive of negative. Positive reinforcement occurs when a behavior is strengthened by adding a rewarding stimulus, while negative reinforcement occurs when a behavior is strengthened by removing an unpleasant stimulus. A punisher is a stimulus that decreases the likelihood of a behavior being repeated. Positive punishment occurs when a behavior is reduced in frequency by adding an unpleasant stimulus, while negative punishment occurs when a behavior is reduced in frequency by removing a pleasant stimulus.
Primary reinforcers are instinctual desires such as food, water, social approval, and sex. Secondary reinforcers, also known as conditioned reinforcers, are not innately appreciated and people have to learn to like them through classical conditioning of other methods. Secondary reinforcers include things such as money. Different patterns of reinforcement have different influences on the response. There are five main reinforcement schedules: fixed interval, variable interval, fixed ratio, variable ratio, and random. Variable ratio schedules are most resistant to extinction.
Shaping and chaining are techniques used when an exact behavior cannot be performed and so cannot be rewarded. Shaping involves rewarding successive, increasingly accurate approximations to the behavior, while chaining involves breaking a complex task into smaller, more manageable sections. Escape conditioning refers to a situation whereby an aversive situation is removed after a response. It is a form of negative reinforcement. Habituation refers to the phenomenon whereby there is a decrease in response to a stimulus over time. Covert sensitization is a technique used whereby someone learns to use mental imagery to associate a behavior with a negative consequence.
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This question is part of the following fields:
- Social Psychology
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Question 15
Correct
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In what area of human behavior did Lorenz develop his ideas based on his research with birds?
Your Answer: Aggression
Explanation:Theories of aggression can be categorized into three main perspectives: psychodynamic, sociological/drive, and cognitive and learning. Psychodynamic theory, proposed by Freud, suggests that aggression arises from a primary instinct called thanatos, which aims for destruction and death. Sociobiological/drive theory, proposed by Lorenz, suggests that aggression is instinctual and necessary for survival, and that stronger genes are selected through aggression. Cognitive and learning theory, proposed by Berkowitz, Rotter, Bandura, and Anderson, suggests that aggression can be learned through observational learning and is influenced by environmental factors. Bandura’s work introduced the concept of reciprocal determinism, which suggests that behavior is influenced by both the environment and the individual’s behavior. Rotter’s social learning theory emphasizes the interaction between the individual and their environment, while Anderson and Bushman’s general aggression model considers the role of social, cognitive, developmental, and biological factors on aggression.
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This question is part of the following fields:
- Social Psychology
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Question 16
Correct
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A 65-year-old man who suffered a head injury is unable to retrieve previously learned information from his memory. What specific aspect of memory function is impaired?
Your Answer: Retrieval
Explanation:Long term memory can be categorized into five functions: Registration, Retention, Retrieval, Recall, and Recognition. Memory issues can arise in any of these areas. Retrieval refers to the ability to retrieve stored information from memory, and its loss indicates an organic cause. Registration involves the ability to add new information to the memory store, which can occur through repeated exposure of a single presentation. Retention refers to the ability to store information that can be retrieved later. Recall is the act of bringing stored information back into consciousness at a specific time. Recognition is the feeling of familiarity that accompanies the retrieval of stored information, and while it is related to memory, it is not strictly a part of the memory process.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 17
Incorrect
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Which statement below best describes Cotard's syndrome?
Your Answer: Has an insidious onset
Correct Answer: Occurs mostly in elderly age group
Explanation:Cotard’s syndrome is a disorder characterized by sudden onset of nihilistic delusions, including beliefs of poverty, negation, and meaninglessness. Hypochondriacal delusions and feelings of guilt may also be present. This condition is more prevalent in elderly individuals and females, and is often associated with depression and organic illnesses.
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This question is part of the following fields:
- Diagnosis
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Question 18
Correct
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What is the process that involves the transfer of amino acids to the ribosome during translation?
Your Answer: tRNA
Explanation:Genomics: Understanding DNA, RNA, Transcription, and Translation
Deoxyribonucleic acid (DNA) is a molecule composed of two chains that coil around each other to form a double helix. DNA is organised into chromosomes, and each chromosome is made up of DNA coiled around proteins called histones. RNA, on the other hand, is made from a long chain of nucleotide units and is usually single-stranded. RNA is transcribed from DNA by enzymes called RNA polymerases and is central to protein synthesis.
Transcription is the synthesis of RNA from a DNA template, and it consists of three main steps: initiation, elongation, and termination. RNA polymerase binds at a sequence of DNA called the promoter, and the transcriptome is the collection of RNA molecules that results from transcription. Translation, on the other hand, refers to the synthesis of polypeptides (proteins) from mRNA. Translation takes place on ribosomes in the cell cytoplasm, where mRNA is read and translated into the string of amino acid chains that make up the synthesized protein.
The process of translation involves messenger RNA (mRNA), transfer RNA (tRNA), and ribosomal RNA (rRNA). Transfer RNAs, of tRNAs, connect mRNA codons to the amino acids they encode, while ribosomes are the structures where polypeptides (proteins) are built. Like transcription, translation also consists of three stages: initiation, elongation, and termination. In initiation, the ribosome assembles around the mRNA to be read and the first tRNA carrying the amino acid methionine. In elongation, the amino acid chain gets longer, and in termination, the finished polypeptide chain is released.
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This question is part of the following fields:
- Genetics
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Question 19
Correct
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A 25-year-old woman is part of a group trying to decide on a restaurant for dinner. When the group suggests a popular Italian restaurant, the other 4 members all say they want to go there. The woman is hesitant, but ultimately agrees with the group's choice.
Which group process is at play here?Your Answer: Conformity
Explanation:Social Influence Phenomena
Conformity is a social influence phenomenon where individuals tend to adopt the attitudes, beliefs, and behaviors of a group, aligning themselves with group norms. The bystander effect is another social influence phenomenon where individuals fail to offer help to a victim when others are present. The likelihood of help decreases as the number of bystanders increases. Groupthink occurs when a group makes poor decisions due to group pressures that lead to a decline in mental efficiency, reality testing, and moral judgment. Polarization is the tendency for a group to make decisions that are more extreme than the initial inclinations of its members. Deindividuation is the loss of self-awareness in groups, often leading to violent acts in situations such as football hooliganism.
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This question is part of the following fields:
- Social Psychology
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Question 20
Correct
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Who is credited with creating the term 'catatonia'?
Your Answer: Kahlbaum
Explanation:– Catatonia is a psychiatric syndrome characterized by disturbed motor functions, mood, and thought.
– Key behaviors associated with catatonia include stupor, posturing, waxy flexibility, negativism, automatic obedience, mitmachen, mitgehen, ambitendency, psychological pillow, forced grasping, obstruction, echopraxia, aversion, mannerisms, stereotypies, motor perseveration, echolalia, and logorrhoea.
– These behaviors are often tested in exam questions.
– Karl Ludwig Kahlbaum is credited with the original clinical description of catatonia. -
This question is part of the following fields:
- Classification And Assessment
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Question 21
Correct
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Which enzyme is believed to play a role in the likelihood of developing alcohol addiction?
Your Answer: Aldehyde dehydrogenase
Explanation:Functional polymorphisms in two alcohol dehydrogenase genes (ADHIB and ADH1C on chromosome 4) and one aldehyde dehydrogenase gene (ALDH2 on chromosome 12) have been linked to lower rates of alcohol dependence. The strongest association is with the ALDH2*2 allele, which is almost exclusively found in Asian populations. Other alleles, such as ADH1B*2, ADH1B*3, and ADHlC*i, found in varying prevalence in different ethnic groups, have also been associated with lower rates of alcohol dependence.
The proposed mechanism for these associations is that the isoenzymes encoded by these alleles lead to an accumulation of acetaldehyde during alcohol metabolism. ALDH2*2 theoretically leads to a slower removal of acetaldehyde than ALDH2*1, while ADH1B*2 and ADH1B*3 lead to a more rapid production of acetaldehyde than ADHIB*I. It is believed that higher levels of acetaldehyde cause more intense reactions to alcohol and lead to lower levels of alcohol intake.
Genetics and Alcoholism
Alcoholism tends to run in families, and several studies confirm that biological children of alcoholics are more likely to develop alcoholism even when adopted by parents without the condition. Monozygotic twins have a greater concordance rate for alcoholism than dizygotic twins. Heritability estimates range from 45 to 65 percent for both men and women. While genetic differences affect risk, there is no “gene for alcoholism,” and both environmental and social factors weigh heavily on the outcome.
The genes with the clearest contribution to the risk for alcoholism and alcohol consumption are alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2). The first step in ethanol metabolism is oxidation to acetaldehyde, by ADHs. The second step is metabolism of the acetaldehyde to acetate by ALDHs. Individuals carrying even a single copy of the ALDH2*504K display the “Asian flushing reaction” when they consume even small amounts of alcohol. There is one significant genetic polymorphism of the ALDH2 gene, resulting in allelic variants ALDH2*1 and ALDH2*2, which is virtually inactive. ALDH2*2 is present in about 50 percent of the Taiwanese, Han Chinese, and Japanese populations. It is extremely rare outside Asia. Nearly no individuals of European of African descent carry this allele. ALDH2*504K has repeatedly been demonstrated to have a protective effect against alcohol use disorders.
The three different class I gene loci, ADH1A (alpha), ADH1B (beta), and ADH1C (gamma) are situated close to each other in the region 4q2123. The alleles ADH1C*1 and ADH1B*2 code for fast metabolism of alcohol. The ADH1B*1 slow allele is very common among Caucasians, with approximately 95 percent having the homozygous ADH1B*1/1 genotype and 5 percent having the heterozygous ADH1B*1/2 genotype. The ADH1B*2 allele is the most common allele in Asian populations. In African populations, the ADH1B*1 allele is the most common.
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This question is part of the following fields:
- Genetics
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Question 22
Correct
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What are the professional standards that doctors in the UK are expected to adhere to?
Your Answer: The GMC permits doctors to accept gifts from patients
Explanation:Professionalism and UK Regulation
Oaths and declarations are important in establishing trust and credibility for professions. The Hippocratic Oath, dating back to 425 BC, is a part of the Western medical tradition and emphasizes the teaching of medicine, patient’s best interests, confidentiality, and abstinence from harmful practices. However, it does not mention concepts such as autonomy of justice and forbids surgery. The Declaration of Geneva (1948) and the Declaration of Helsinki (1964) are modern-day versions of the Hippocratic Oath, emphasizing the patient’s health and interests over science and society. These declarations arose from the concern of the medical community’s complicity with the Nazi party during World War II.
In the UK, doctors must register with the General Medical Council (GMC), which sets professional standards and maintains a register of licensed doctors. It is illegal to practice medicine without a license in the UK. The GMC’s Good Medical Practice and the Good Medical Practice: Framework for Appraisal and Revalidation document emphasizes the duty of doctors to be honest and trustworthy, with dishonesty viewed harshly. Confidentiality is an important legal and ethical duty, but it is not absolute. Breaches of confidentiality may occur in emergencies, in the interests of others, when required by statute of the courts, of when required by the Driver and Vehicle Licensing Agency (DVLA). Sexualized relationships with current patients are prohibited, and accepting unsolicited gifts from patients is allowed but must not affect the way doctors prescribe, advise, treat, refer, of commission services.
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This question is part of the following fields:
- Social Psychology
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Question 23
Incorrect
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What is a true statement about the planum temporale?
Your Answer: It tends to be larger on the right hand side of the brain
Correct Answer: Planum temporale asymmetry is more prominent in males than in females
Explanation:Cerebral Asymmetry in Planum Temporale and its Implications in Language and Auditory Processing
The planum temporale, a triangular region in the posterior superior temporal gyrus, is a highly lateralized brain structure involved in language and music processing. Studies have shown that the planum temporale is up to ten times larger in the left cerebral hemisphere than the right, with this asymmetry being more prominent in men. This asymmetry can be observed in gestation and is present in up to 70% of right-handed individuals.
Recent research suggests that the planum temporale also plays an important role in auditory processing, specifically in representing the location of sounds in space. However, reduced planum temporale asymmetry has been observed in individuals with dyslexia, stuttering, and schizophrenia. These findings highlight the importance of cerebral asymmetry in the planum temporale and its implications in language and auditory processing.
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This question is part of the following fields:
- Neurosciences
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Question 24
Correct
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What is the sole authorized therapy for tardive dyskinesia in the United Kingdom?
Your Answer: Tetrabenazine
Explanation:Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).
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This question is part of the following fields:
- Psychopharmacology
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Question 25
Correct
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What is a personality disorder category in ICD-10?
Your Answer: Anankastic personality disorder
Explanation:ICD-10’s Anankastic personality disorder is the same as DSM V obsessive-compulsive personality disorder, while inadequate and passive aggressive personality disorders are not recognized in either classification system. Additionally, DSM V includes narcissistic personality disorder as a distinct category of personality disorder.
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This question is part of the following fields:
- Classification And Assessment
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Question 26
Correct
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Which drug class is most likely to result in QTc interval prolongation?
Your Answer: Antimalarials
Explanation:Amantadine and QTc Prolongation
Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.
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This question is part of the following fields:
- Psychopharmacology
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Question 27
Incorrect
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During which stages of Tanner development do males experience their growth spurt?
Your Answer: 2-Mar
Correct Answer:
Explanation:Puberty
Puberty is a natural process that occurs in both boys and girls. The age range for the onset of puberty is between 8-14 years for females and 9-14 years for males, with the mean age of onset being 11 years for girls and 12 years for boys. The duration of puberty is typically 3-4 years. The onset of puberty is marked by the appearance of secondary sex characteristics, such as breast development in females and testicular enlargement in males. These characteristics evolve over time and are rated into 5 stages according to Tanner’s criteria. The sequence of events differs between boys and girls, with the onset of breast development (thelarche) generally preceding the onset of the first period (menarche) by around 2 years in girls. The pubertal growth spurt occurs during stages 3 to 4 in most boys and during stages 2 and 3 in girls. Precocious puberty, which occurs earlier than usual, is more common in girls than in boys. The age of onset of puberty in girls has been decreasing over time, with environmental factors such as nutrition potentially playing a role in this trend.
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This question is part of the following fields:
- Psychological Development
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Question 28
Correct
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What is a substance that activates GABA-B receptors called?
Your Answer: Baclofen
Explanation:Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.
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This question is part of the following fields:
- Neurosciences
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Question 29
Correct
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What diagnostic tool is utilized to determine the underlying reason for ataxia?
Your Answer: Romberg's test
Explanation:A positive Romberg test suggests the presence of sensory ataxia.
Romberg’s Test for Investigating Ataxia
Romberg’s test is a diagnostic tool used to determine the cause of ataxia. A positive result indicates that the cause is sensory in nature. The test involves asking the patient to stand upright with their feet together and eyes closed. If the patient begins to sway of fall over, the test is considered positive. In cases where there is a cerebellar problem, the patient will exhibit ataxia even when their eyes are open. Romberg’s test is an important tool in diagnosing ataxia and determining the underlying cause of the condition.
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This question is part of the following fields:
- Classification And Assessment
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Question 30
Incorrect
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Which statement accurately describes the SF-36?
Your Answer: It is a structured interview
Correct Answer: It is a self-administered questionnaire
Explanation:SF-36: A Patient-Reported Survey for Measuring Functioning and Well-Being
The SF-36, also known as the Short-form 36, is a survey consisting of 36 items that patients can complete to rate their functioning and well-being. The survey is designed to measure eight different scales, with four pertaining to physical health and four to mental health. The physical health scales include physical functioning, role limitations due to physical health problems, bodily pain, and general health. The mental health scales include vitality (energy/fatigue), social functioning, role limitations due to emotional problems, and mental health (psychological distress and psychological well-being). Patients can complete the survey on their own, and it typically takes around eight minutes to finish.
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This question is part of the following fields:
- Classification And Assessment
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Question 31
Correct
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What is the name of the attitude assessment scale that typically employs a seven-point scale and presents bipolar options like 'strong' of 'weak'?
Your Answer: Semantic Differential Scale
Explanation:Attitude scales are used to measure a person’s feelings and thoughts towards something. There are several types of attitude scales, including the Thurstone scale, Likert scale, semantic differential scale, and Gutman scale. The Thurstone scale involves creating a list of statements and having judges score them based on their negativity of positivity towards an issue. Respondents then indicate whether they agree of disagree with each statement. The Likert scale asks respondents to indicate their degree of agreement of disagreement with a series of statements using a five-point scale. The semantic differential scale presents pairs of opposite adjectives and asks respondents to rate their position on a five- of seven-point scale. The Gutman scale involves a list of statements that can be ordered hierarchically, with each statement having a corresponding weight. Respondents’ scores on the scale indicate the number of statements they agree with.
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This question is part of the following fields:
- Classification And Assessment
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Question 32
Correct
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How can we describe the absence of a link between two successive ideas?
Your Answer: Asyndesis
Explanation:Echolalia refers to the act of repeating someone else’s spoken words without any meaningful connection of context. This behavior is often observed in individuals with certain neurological of developmental disorders.
Formal Thought Disorders
In formal thought disorders, changes in the speed, coherence, and cogency of thought can be observed from a patient’s speech. These disorders can also be self-reported and may be accompanied by enhanced use of nonverbal language. One possible indication is a lack of an adequate connection between two consecutive thoughts, which is called ‘asyndesis’.
There are several types of formal thought disorders, including inhibited thinking, retarded thinking, circumstantial thinking, restricted thinking, perseverative thinking, rumination, pressured thinking, flight of ideas, tangential thinking, thought blocking, disruption of thought, incoherence/derailment, and neologisms.
Inhibited thinking is about the subjective experience of the patient, who may feel that their thinking process is slowed down of blocked by an inner wall of resistance. Retarded thinking, on the other hand, is about the observed quality of thought as inferred through speech, where the flow of thought processes is slowed down and sluggish.
Circumstantial thinking refers to an inability to separate the essential from the unessential during a conversation without rendering the conversation incoherent. Restricted thinking involves a limited range of thought content, fixation on one particular topic of a small number of topics only, and a stereotyped pattern of thinking.
Perseverative thinking is characterized by the persistent repetition of previously used words, phrases, of details to the point where they become meaningless in the context of the current stage of the interview. Rumination is the endless mental preoccupation with, of excessive concern over, mostly unpleasant thoughts.
Pressured thinking, also known as crowding of thought, is when the patient feels helplessly exposed to the pressures of floods of different ideas of thoughts. Flight of ideas involves an increasing multitude of thoughts and ideas which are no longer firmly guided by clear goal-directed thinking.
Tangential thinking occurs when the patient appears to understand the contents of the questions addressed to them but provides answers which are completely out of context. Thought blocking of disruption of thought refers to sudden disruption of an otherwise normal flow of thought of speech for no obvious reason.
Incoherence of derailment is when the interviewer is unable to establish sensible connections between the patient’s thinking and verbal output, which is sometimes also called derailment. Neologisms involve the formation of new words of usage of words which disregard normal conventions and are generally not easily understandable.
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This question is part of the following fields:
- Classification And Assessment
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Question 33
Correct
-
Which of the following is most likely to result from use of carbamazepine?
Your Answer: Leucopenia
Explanation:Carbamazepine use can result in leucopenia, which is a reduction in white blood cell count, affecting 1 in 10 individuals. Although other side effects can occur with carbamazepine, they are rare of very rare. The decrease in WBC is believed to be due to the inhibition of colony-stimulating factor in the bone marrow. However, the co-administration of lithium, which stimulates colony-stimulating factor, may potentially reverse the effects of carbamazepine (Daughton, 2006).
Carbamazepine: Uses, Mechanism of Action, Contraindications, Warnings, and Side-Effects
Carbamazepine, also known as Tegretol, is a medication commonly used in the treatment of epilepsy, particularly partial seizures. It is also used for neuropathic pain, bipolar disorder, and other conditions. The drug works by binding to sodium channels and increasing their refractory period.
However, carbamazepine has notable contraindications, including a history of bone marrow depression and combination with monoamine oxidase inhibitors (MAOIs). It also carries warnings for serious dermatological reactions such as toxic epidermal necrolysis (TEN) and Stevens Johnson syndrome.
Common side-effects of carbamazepine include leucopenia, ataxia, dizziness, somnolence, vomiting, nausea, urticaria, and fatigue. Other side-effects include thrombocytopenia, eosinophilia, oedema, fluid retention, weight increase, hyponatraemia, and blood osmolarity decreased due to an antidiuretic hormone (ADH)-like effect, leading in rare cases to water intoxication accompanied by lethargy, vomiting, headache, confusional state, neurological disorders, diplopia, accommodation disorders (e.g. blurred vision), and dry mouth.
In summary, carbamazepine is a medication with multiple uses, but it also carries significant contraindications, warnings, and side-effects that should be carefully considered before use.
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This question is part of the following fields:
- Psychopharmacology
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Question 34
Correct
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Which of the following best represents a strong indication of being dependent on alcohol?
Your Answer: Raised MCV
Explanation:Alcohol Dependence Blood Profile
Alcohol dependence can have a significant impact on an individual’s blood profile. Several markers tend to be elevated in individuals with alcohol dependence, including GGT, AST, MCV, and ALT. Among these markers, GGT is considered the most reliable indicator of recent alcohol use. This means that elevated levels of GGT in the blood can suggest that an individual has consumed alcohol recently.
It is important to note that these blood markers may not be elevated in all individuals with alcohol dependence, and other factors can also contribute to changes in blood profile. However, monitoring these markers can be useful in assessing an individual’s alcohol use and identifying potential health risks associated with alcohol dependence. Healthcare professionals can use this information to develop appropriate treatment plans and support individuals in managing their alcohol use.
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This question is part of the following fields:
- Classification And Assessment
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Question 35
Correct
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What percentage of Caucasians have a deficiency in the cytochrome P450 enzyme 2D6?
Your Answer: 6%
Explanation:Debrisoquine hydroxylase is the primary enzyme responsible for metabolizing several antidepressants, such as tricyclics, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and others. Approximately 5 out of 100 individuals are poor metabolisers, which can lead to increased side effects from medications that rely on CYP2D6 for metabolism. Conversely, ultra-rapid metabolisers may require higher than average doses of these medications due to their highly active forms of the enzyme.
The Cytochrome P450 system is a group of enzymes that metabolize drugs by altering their functional groups. The system is located in the liver and small intestine and is involved in drug interactions through enzyme induction of inhibition. Notable inducers include smoking, alcohol, and St John’s Wort, while notable inhibitors include grapefruit juice and some SSRIs. CYP2D6 is important due to genetic polymorphism, and CYP3A4 is the most abundant subfamily and is commonly involved in interactions. Grapefruit juice inhibits both CYP1A2 and CYP3A4, while tobacco smoking induces CYP1A2. The table summarizes the main substrates, inhibitors, and inducers for each CYP enzyme.
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This question is part of the following fields:
- Psychopharmacology
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Question 36
Correct
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An important function of hepatic metabolism is to make a drug:
Your Answer: More water soluble
Explanation:Understanding Biotransformation: A Metabolic Process for Excretion
Biotransformation is a metabolic process that occurs primarily in the liver, but also in other organs such as the kidneys, intestine, adipose, skin, and lungs. Its main function is to facilitate the excretion of both exogenous and endogenous substances by altering their chemical structures through a series of reactions. Enzymes found in the cytoplasm, endoplasmic reticulum, and mitochondria of cells catalyze these reactions, which can cause the substrate to become inactive, active, of even toxic.
Biotransformation is divided into three phases. Phase I reactions involve oxidation, reduction, of hydrolysis of the drug, yielding a polar, water-soluble metabolite that is often still active. Phase II reactions consist of adding hydrophilic groups to the original molecule, a toxic intermediate, of a nontoxic metabolite formed in phase I, to increase its polarity. The most common method is conjugation with glucuronic acid, but other groups such as sulphate, amino acids, acetate, and methyl can also be added. Phase III reactions occur post-phase II, where a chemical substance can undergo further metabolism and excretion through active transport into the urinary of hepatobiliary system.
Understanding biotransformation is crucial in pharmacology and toxicology, as it affects the efficacy and toxicity of drugs and other substances. By facilitating the excretion of these substances, biotransformation helps maintain homeostasis in the body and prevent accumulation of potentially harmful compounds.
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This question is part of the following fields:
- Psychopharmacology
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Question 37
Correct
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Which statement accurately defines the concept of fundamental attribution error?
Your Answer: Attributing others mistakes to their personal dispositions
Explanation:The fundamental attribution error pertains to our tendency to make biased judgments about the behavior of others, rather than our own.
Attribution Theory: Understanding How We Explain Events
Attribution theory provides a framework for understanding how individuals explain events in their environment. It examines how people use information to arrive at causal explanations for events and what factors influence their judgments. Fritz Heider first proposed a theory of attribution in 1958.
However, attribution is prone to biases such as the Fundamental Attribution Error (FAE), which overemphasizes dispositional factors over situational causes when making attributions about others’ behavior. The Actor-Observer Bias, on the other hand, undervalues dispositional explanations and overvalued situational explanations of our own behavior. Correspondence bias is the tendency to draw inferences about a person’s unique and enduring dispositions from behaviors that can be entirely explained by the situations in which they occur. Self-serving bias refers to people’s tendency to attribute their successes to internal factors but attribute their failures to external factors. Hostile Attribution Bias (HAB) is an interpretive bias where individuals interpret ambiguous behavior as hostile, leading to aggression. Finally, the False Consensus Effect is the tendency for people to project their way of thinking onto others, assuming that everyone else thinks the same way they do.
Overall, attribution theory helps us understand how people make sense of events in their environment, but it is important to be aware of the biases that can influence our judgments.
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This question is part of the following fields:
- Social Psychology
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Question 38
Incorrect
-
Anomic aphasia is most likely to occur due to a lesion in which area?
Your Answer:
Correct Answer: Angular gyrus
Explanation:The parahippocampal gyrus is located surrounding the hippocampus and is involved in memory processing. Asymmetry in this area has also been observed in individuals with schizophrenia.
Aphasia is a language impairment that affects the production of comprehension of speech, as well as the ability to read of write. The areas involved in language are situated around the Sylvian fissure, referred to as the ‘perisylvian language area’. For repetition, the primary auditory cortex, Wernicke, Broca via the Arcuate fasciculus (AF), Broca recodes into articulatory plan, primary motor cortex, and pyramidal system to cranial nerves are involved. For oral reading, the visual cortex to Wernicke and the same processes as for repetition follows. For writing, Wernicke via AF to premotor cortex for arm and hand, movement planned, sent to motor cortex. The classification of aphasia is complex and imprecise, with the Boston Group classification and Luria’s aphasia interpretation being the most influential. The important subtypes of aphasia include global aphasia, Broca’s aphasia, Wernicke’s aphasia, conduction aphasia, anomic aphasia, transcortical motor aphasia, and transcortical sensory aphasia. Additional syndromes include alexia without agraphia, alexia with agraphia, and pure word deafness.
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This question is part of the following fields:
- Neurosciences
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Question 39
Incorrect
-
What is a suitable alternative for a patient who has lithium-induced diabetes insipidus and cannot be switched to a different medication?
Your Answer:
Correct Answer: Amiloride
Explanation:It is not advisable to limit fluid intake in cases of lithium-induced DI as it can result in severe hypernatremia.
Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 40
Incorrect
-
The acquaintances of a 60-year-old wealthy individual reached out to social services after noticing a foul smell coming from their residence. The person has been isolating themselves for the past three years. Upon inspection, it was evident that they were living in unsanitary conditions and neglecting their personal hygiene. What is the most probable scenario in this situation?
Your Answer:
Correct Answer: Diogenes syndrome
Explanation:Diogenes syndrome is a condition where elderly reclusive individuals, often wealthy and intelligent, exhibit gross self-neglect without necessarily having a psychiatric illness. It is named after an ancient Greek philosopher known for his simple lifestyle. Briquet’s syndrome, now called somatisation syndrome, is a chronic condition where individuals have multiple physical complaints across various systems without any physical cause found. Cotard’s syndrome is a type of psychotic depression in the elderly, characterized by nihilistic and hypochondriacal delusions, along with a depressed mood and either retardation of agitation. Munchausen’s syndrome is a factitious disorder where individuals repeatedly seek medical treatment for false symptoms and history, seemingly motivated by assuming the role of a patient and receiving care.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 41
Incorrect
-
Which base pairs are found within DNA?
Your Answer:
Correct Answer: Guanine and cytosine
Explanation:Genomics: Understanding DNA, RNA, Transcription, and Translation
Deoxyribonucleic acid (DNA) is a molecule composed of two chains that coil around each other to form a double helix. DNA is organised into chromosomes, and each chromosome is made up of DNA coiled around proteins called histones. RNA, on the other hand, is made from a long chain of nucleotide units and is usually single-stranded. RNA is transcribed from DNA by enzymes called RNA polymerases and is central to protein synthesis.
Transcription is the synthesis of RNA from a DNA template, and it consists of three main steps: initiation, elongation, and termination. RNA polymerase binds at a sequence of DNA called the promoter, and the transcriptome is the collection of RNA molecules that results from transcription. Translation, on the other hand, refers to the synthesis of polypeptides (proteins) from mRNA. Translation takes place on ribosomes in the cell cytoplasm, where mRNA is read and translated into the string of amino acid chains that make up the synthesized protein.
The process of translation involves messenger RNA (mRNA), transfer RNA (tRNA), and ribosomal RNA (rRNA). Transfer RNAs, of tRNAs, connect mRNA codons to the amino acids they encode, while ribosomes are the structures where polypeptides (proteins) are built. Like transcription, translation also consists of three stages: initiation, elongation, and termination. In initiation, the ribosome assembles around the mRNA to be read and the first tRNA carrying the amino acid methionine. In elongation, the amino acid chain gets longer, and in termination, the finished polypeptide chain is released.
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This question is part of the following fields:
- Genetics
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Question 42
Incorrect
-
A 35-year-old woman with mild anxiety was prescribed an antidepressant but experienced sexual side effects. Her doctor suggested switching to a medication that is a serotonin norepinephrine reuptake inhibitor (SNRI). What is an example of an SNRI?
Your Answer:
Correct Answer: Milnacipran
Explanation:SNRIs are a type of antidepressant medication that work by blocking the reuptake of both serotonin and norepinephrine, providing two mechanisms to help with the antidepressant effect. They are particularly effective at inhibiting the norepinephrine transporter compared to the serotonin transporter. Examples of SNRIs include Venlafaxine, Desvenlafaxine, Duloxetine, and Milnacipran. Bupropion is a different type of antidepressant that works by inhibiting the reuptake of norepinephrine and dopamine (NDRI). Escitalopram is a selective serotonin reuptake inhibitor (SSRI), while Mirtazapine is a noradrenergic and specific serotonin antidepressant (NaSSA). Nefazodone is a serotonin antagonist/reuptake inhibitor (SARI).
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This question is part of the following fields:
- Psychopharmacology
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Question 43
Incorrect
-
Which of the following is most likely to cause dysgeusia?
Your Answer:
Correct Answer: Lithium
Explanation:Taste disturbance is known as Dysgeusia in medical terminology and can be caused by various medications. Lithium is a frequently encountered culprit, but other drugs such as certain antidepressants, benzodiazepines, z-drugs, and opiates can also lead to this condition. Additionally, any medication that causes dry mouth may result in taste disturbance. This information is sourced from D Kaufman’s book, Clinical neurology for psychiatrists, published in 2007 on page 38.
Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 44
Incorrect
-
A clinical trial involving participants with depression administered an intravenous infusion of a trial drug, while the control arm received midazolam (benzodiazepine). Within 24 hours of the infusion, those in the active arm of the trial exhibited a higher average response on the clinical rating scale and a greater number of responders overall. However, notable side effects were observed in the active trial arm, including dizziness, blurred vision, headache, nausea of vomiting, dry mouth, poor coordination, poor concentration, feelings of dissociation, and restlessness. What is the most likely drug used in the active arm of the trial?
Your Answer:
Correct Answer: Ketamine
Explanation:Ketamine, typically used in emergency medicine and paediatric anaesthesia, has been found to possess antidepressant properties and is currently being studied for its rapid onset efficacy. However, its acute side effect of inducing dissociation has raised concerns about its suitability for individuals with psychotic symptoms of emotionally unstable personality disorder.
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This question is part of the following fields:
- Psychopharmacology
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Question 45
Incorrect
-
What factor is most likely to worsen a patient's psoriasis?
Your Answer:
Correct Answer: Lithium
Explanation:Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 46
Incorrect
-
What is the EEG waveform with the slowest frequency?
Your Answer:
Correct Answer: Delta
Explanation:EEG Waveform Frequencies
Delta waves have the lowest frequency among the EEG waveforms, ranging from 0.5 to 4 Hz. Theta waves follow with a frequency range of 4 to 8 Hz, while alpha waves have a frequency range of 8 to 14 Hz. Beta waves have a frequency range of 14 to 32 Hz, and gamma waves have a frequency range of 32 to 48+ Hz. In a normal awake adult EEG, alpha waves are the most prominent waveform.
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This question is part of the following fields:
- Neurosciences
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Question 47
Incorrect
-
What stage of sleep do most adults spend the majority of their time in during the night?
Your Answer:
Correct Answer: Stage 2
Explanation:– Dement and Kleitman (1957) classified sleep into five stages.
– Normal adults spend the majority of their sleep in Stage 2 (55%).
– Non-REM sleep is divided into four stages: Stage 1 (5%), Stage 2 (55%), Stage 3 (5%), and Stage 4 (10%).
– REM sleep is Stage 5 and normal adults spend 25% of their sleep in this stage. -
This question is part of the following fields:
- Neurosciences
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Question 48
Incorrect
-
A client is referred with depression and is eager to begin medication. You find out that they have hypertension. What would be the most suitable treatment option?
Your Answer:
Correct Answer: Fluoxetine
Explanation:Antidepressants and Diabetes
Depression is a prevalent condition among patients with diabetes. It is crucial to select the appropriate antidepressant as some may have negative effects on weight and glucose levels. The first-line treatment for depression in diabetic patients is selective serotonin reuptake inhibitors (SSRIs), with fluoxetine having the most supporting data. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also likely to be safe, but there is less evidence to support their use. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) should be avoided. These recommendations are based on the Maudsley Guidelines 10th Edition.
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This question is part of the following fields:
- Psychopharmacology
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Question 49
Incorrect
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Question 50
Incorrect
-
Which of the options works by temporarily blocking the activity of cholinesterase through reversible inhibition?
Your Answer:
Correct Answer: Rivastigmine
Explanation:Mechanisms of Action of Different Drugs
Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.
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This question is part of the following fields:
- Psychopharmacology
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Question 51
Incorrect
-
What cell type plays a significant role in the formation of the blood-brain barrier?
Your Answer:
Correct Answer: Astrocyte
Explanation:Glial Cells: The Support System of the Central Nervous System
The central nervous system is composed of two basic cell types: neurons and glial cells. Glial cells, also known as support cells, play a crucial role in maintaining the health and function of neurons. There are several types of glial cells, including macroglia (astrocytes and oligodendrocytes), ependymal cells, and microglia.
Astrocytes are the most abundant type of glial cell and have numerous functions, such as providing structural support, repairing nervous tissue, nourishing neurons, contributing to the blood-brain barrier, and regulating neurotransmission and blood flow. There are two main types of astrocytes: protoplasmic and fibrous.
Oligodendrocytes are responsible for the formation of myelin sheaths, which insulate and protect axons, allowing for faster and more efficient transmission of nerve impulses.
Ependymal cells line the ventricular system and are involved in the circulation of cerebrospinal fluid (CSF) and fluid homeostasis in the brain. Specialized ependymal cells called choroid plexus cells produce CSF.
Microglia are the immune cells of the CNS and play a crucial role in protecting the brain from infection and injury. They also contribute to the maintenance of neuronal health and function.
In summary, glial cells are essential for the proper functioning of the central nervous system. They provide structural support, nourishment, insulation, and immune defense to neurons, ensuring the health and well-being of the brain and spinal cord.
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This question is part of the following fields:
- Neurosciences
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Question 52
Incorrect
-
What is the mechanism by which antipsychotic use leads to erectile dysfunction?
Your Answer:
Correct Answer: Cholinergic receptor antagonism
Explanation:Antipsychotics and Sexual Dysfunction: Causes, Risks, and Management
Sexual dysfunction is a common side effect of antipsychotic medication, with the highest risk associated with risperidone and haloperidol due to their effect on prolactin levels. Clozapine, olanzapine, quetiapine, aripiprazole, asenapine, and lurasidone are associated with lower rates of sexual dysfunction. The Arizona Sexual Experiences Scale (ASEX) can be used to measure sexual dysfunction before and during treatment. Management options include excluding other causes, watchful waiting, dose reduction, switching to a lower risk agent, adding aripiprazole, considering an antidote medication, of using sildenafil for erectile dysfunction. It is important to address sexual dysfunction to improve quality of life and medication adherence.
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This question is part of the following fields:
- Psychopharmacology
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Question 53
Incorrect
-
Can you provide an example of a drug interaction that affects the way a drug works in the body?
Your Answer:
Correct Answer: Competition at a receptor
Explanation:Drug Interactions: Understanding the Different Types
Drug interactions can occur in different ways, and it is important to understand the different types to avoid potential harm. Pharmacokinetic drug interactions happen when one drug affects the metabolism, absorption, of excretion of another drug. This can be due to enzyme induction of inhibition, changes in gastrointestinal tract motility and pH, chelation, competition for renal tubular transport, of changes in protein binding. On the other hand, pharmacodynamic drug interactions occur when one drug directly alters the effect of another drug. This can happen through synergism, antagonism, of interaction at receptors, such as allosteric modulation. It is important to note that pharmacodynamic drug interactions do not involve any absorption, distribution, metabolism, of excretion processes directly. By understanding the different types of drug interactions, healthcare professionals can better manage patients’ medications and prevent potential adverse effects.
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This question is part of the following fields:
- Psychopharmacology
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Question 54
Incorrect
-
Which topic is covered by the Fraser Guidelines?
Your Answer:
Correct Answer: The provision of contraceptives to people 16 and under
Explanation:Gillick Competency and Fraser Guidelines
Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice of treatment to under 16-year-olds without parental consent. But since then, they have been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.
In 1982, Mrs Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice of treatment to under 16-year-olds without parental consent.
The case went to the High Court where Mr Justice Woolf dismissed Mrs Gillick’s claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgement delivered by Mr Justice Woolf.
The Fraser Guidelines were laid down by Lord Fraser in the House of Lords’ case and state that it is lawful for doctors to provide contraceptive advice and treatment without parental consent providing that they are satisfied that:
– The young person will understand the professional’s advice
– The young person cannot be persuaded to inform their parents
– The young person is likely to begin, of to continue having, sexual intercourse with of without contraceptive treatment
– Unless the young person receives contraceptive treatment, their physical of mental health, of both, are likely to suffer
– The young person’s best interests require them to receive contraceptive advice of treatment with of without parental consent. -
This question is part of the following fields:
- Classification And Assessment
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Question 55
Incorrect
-
Which of the following is the most commonly associated condition with Velo-cardio-facial syndrome?
Your Answer:
Correct Answer: Psychosis
Explanation:Psychosis is linked to Velo-cardio-facial syndrome.
Velo-Cardio-Facial Syndrome and Psychiatric Disorders
Velo-cardio-facial syndrome (VCFS) is a genetic disorder that is characterized by distinct physical features, congenital heart disease, and learning disabilities. It is caused by small deletions in chromosome 22q11. There have been numerous studies that suggest a link between VCFS and psychiatric disorders.
One of the strongest associations is with psychotic illnesses, such as schizophrenia. This has led researchers to use VCFS as a model for understanding the genetics and pathogenesis of schizophrenia. VCFS provides a unique opportunity to study the genetic and environmental factors that contribute to the development of psychiatric disorders.
Overall, the link between VCFS and psychiatric disorders highlights the importance of understanding the genetic and environmental factors that contribute to mental illness. By studying VCFS, researchers can gain insight into the underlying mechanisms of psychiatric disorders and develop new treatments and interventions.
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This question is part of the following fields:
- Genetics
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Question 56
Incorrect
-
Under normal circumstances, which stage of sleep is responsible for the largest portion of total sleep time?
Your Answer:
Correct Answer: Stage II
Explanation:Sleep Stages
Sleep is divided into two distinct states called rapid eye movement (REM) and non-rapid eye movement (NREM). NREM is subdivided into four stages.
Sleep stage
Approx % of time spent in stage
EEG findings
CommentI
5%
Theta waves (4-7 Hz)
The dozing off stage. Characterized by hypnic jerks: spontaneous myoclonic contractions associated with a sensation of twitching of falling.II
45%
Theta waves, K complexes and sleep spindles (short bursts of 12-14 Hz activity)
Body enters a more subdued state including a drop in temperature, relaxed muscles, and slowed breathing and heart rate. At the same time, brain waves show a new pattern and eye movement stops.III
15%
Delta waves (0-4 Hz)
Deepest stage of sleep (high waking threshold). The length of stage 3 decreases over the course of the night.IV
15%
Mixed, predominantly beta
High dream activity.The percentage of REM sleep decreases with age.
It takes the average person 15-20 minutes to fall asleep, this is called sleep latency (characterised by the onset of stage I sleep). Once asleep one descends through stages I-II and then III-IV (deep stages). After about 90 minutes of sleep one enters REM. The rest of the sleep comprises of cycles through the stages. As the sleep progresses the periods of REM become greater and the periods of NREM become less. During an average night’s sleep one spends 25% of the sleep in REM and 75% in NREM.
REM sleep has certain characteristics that separate it from NREM
Characteristics of REM sleep
– Autonomic instability (variability in heart rate, respiratory rate, and BP)
– Loss of muscle tone
– Dreaming
– Rapid eye movements
– Penile erectionDeafness:
(No information provided on deafness in relation to sleep stages)
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This question is part of the following fields:
- Neurosciences
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Question 57
Incorrect
-
What is the area of the brain that is responsible for causing the Klüver-Bucy syndrome when it experiences dysfunction on both sides?
Your Answer:
Correct Answer: Temporal lobe
Explanation:Kluver-Bucy Syndrome: Causes and Symptoms
Kluver-Bucy syndrome is a neurological disorder that results from bilateral medial temporal lobe dysfunction, particularly in the amygdala. This condition is characterized by a range of symptoms, including hyperorality (a tendency to explore objects with the mouth), hypersexuality, docility, visual agnosia, and dietary changes.
The most common causes of Kluver-Bucy syndrome include herpes, late-stage Alzheimer’s disease, frontotemporal dementia, trauma, and bilateral temporal lobe infarction. In some cases, the condition may be reversible with treatment, but in others, it may be permanent and require ongoing management. If you of someone you know is experiencing symptoms of Kluver-Bucy syndrome, it is important to seek medical attention promptly to determine the underlying cause and develop an appropriate treatment plan.
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This question is part of the following fields:
- Neurosciences
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Question 58
Incorrect
-
What is a true statement about the medications utilized for opioid dependence?
Your Answer:
Correct Answer: Buprenorphine is a partial agonist at the mu receptor
Explanation:Opioid Pharmacology and Treatment Medications
Opioids work by binding to opioid receptors in the brain, specifically the µ, k, and δ receptors. The µ receptor is the main target for opioids and mediates euphoria, respiratory depression, and dependence. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, leading to the reward and euphoria that drives repeated use. However, with repeated exposure, µ receptors become less responsive, leading to dysphoria and drug craving.
There are several medications used in opioid treatment. Methadone is a full agonist targeting µ receptors, with some action against k and δ receptors, and has a half-life of 15-22 hours. However, it carries a risk of respiratory depression, especially when used with hypnotics and alcohol. Buprenorphine is a partial agonist targeting µ receptors, as well as a partial k agonist of functional antagonist and a weak δ antagonist. It has a high affinity for µ receptors and a longer half-life of 24-42 hours, making it safer than methadone. Naloxone is an antagonist targeting all opioid receptors and is used to reverse opioid overdose, with a half-life of 30-120 minutes. However, it can cause noncardiogenic pulmonary edema in some cases. Naltrexone is a reversible competitive antagonist at µ and ĸ receptors, with a half-life of 4-6 hours, and is used as an adjunctive prophylactic treatment for detoxified formerly opioid-dependent people.
Alpha2 adrenergic agonists, such as clonidine and lofexidine, can ameliorate opioid withdrawal symptoms associated with the noradrenaline system, including sweating, shivering, and runny nose and eyes. The locus coeruleus, a nucleus in the pons with a high density of noradrenergic neurons possessing µ-opioid receptors, is involved in wakefulness, blood pressure, breathing, and overall alertness. Exposure to opioids results in heightened neuronal activity of the nucleus cells, and if opioids are not present to suppress this activity, increased amounts of norepinephrine are released, leading to withdrawal symptoms. Clonidine was originally developed as an antihypertensive, but its antihypertensive effects are problematic in detox, so lofexidine was developed as an alternative with less hypotensive effects.
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This question is part of the following fields:
- Psychopharmacology
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Question 59
Incorrect
-
The primary location of the cytochrome P450 system is within which of the following?
Your Answer:
Correct Answer: Endoplasmic reticulum
Explanation:The liver contains a significant number of Cytochrome P450 proteins, which are primarily located in the endoplasmic reticulum membrane. These enzymes are responsible for metabolizing various compounds, both naturally occurring and foreign. Additionally, these proteins can be found in other cellular compartments, including the cell surface and mitochondria, and are present in other areas of the body beyond the liver.
Understanding Biotransformation: A Metabolic Process for Excretion
Biotransformation is a metabolic process that occurs primarily in the liver, but also in other organs such as the kidneys, intestine, adipose, skin, and lungs. Its main function is to facilitate the excretion of both exogenous and endogenous substances by altering their chemical structures through a series of reactions. Enzymes found in the cytoplasm, endoplasmic reticulum, and mitochondria of cells catalyze these reactions, which can cause the substrate to become inactive, active, of even toxic.
Biotransformation is divided into three phases. Phase I reactions involve oxidation, reduction, of hydrolysis of the drug, yielding a polar, water-soluble metabolite that is often still active. Phase II reactions consist of adding hydrophilic groups to the original molecule, a toxic intermediate, of a nontoxic metabolite formed in phase I, to increase its polarity. The most common method is conjugation with glucuronic acid, but other groups such as sulphate, amino acids, acetate, and methyl can also be added. Phase III reactions occur post-phase II, where a chemical substance can undergo further metabolism and excretion through active transport into the urinary of hepatobiliary system.
Understanding biotransformation is crucial in pharmacology and toxicology, as it affects the efficacy and toxicity of drugs and other substances. By facilitating the excretion of these substances, biotransformation helps maintain homeostasis in the body and prevent accumulation of potentially harmful compounds.
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This question is part of the following fields:
- Psychopharmacology
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Question 60
Incorrect
-
Select the correct order of the phases in the cell cycle:
Your Answer:
Correct Answer: G1, S phase, G2, mitosis
Explanation:Cytokinesis: The Final Stage of Cell Division
Cytokinesis is the final stage of cell division, where the cell splits into two daughter cells, each with a nucleus. This process is essential for the growth and repair of tissues in multicellular organisms. In mitosis, cytokinesis occurs after telophase, while in meiosis, it occurs after telophase I and telophase II.
During cytokinesis, a contractile ring made of actin and myosin filaments forms around the cell’s equator, constricting it like a belt. This ring gradually tightens, pulling the cell membrane inward and creating a furrow that deepens until it reaches the center of the cell. Eventually, the furrow meets in the middle, dividing the cell into two daughter cells.
In animal cells, cytokinesis is achieved by the formation of a cleavage furrow, while in plant cells, a cell plate forms between the two daughter nuclei, which eventually develops into a new cell wall. The timing and mechanism of cytokinesis are tightly regulated by a complex network of proteins and signaling pathways, ensuring that each daughter cell receives the correct amount of cytoplasm and organelles.
Overall, cytokinesis is a crucial step in the cell cycle, ensuring that genetic material is equally distributed between daughter cells and allowing for the growth and development of multicellular organisms.
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This question is part of the following fields:
- Genetics
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Question 61
Incorrect
-
A client visiting your practice informs you that they have been informed that grapefruit juice may have an impact on their SSRI antidepressant. What is the most suitable guidance you can provide?
Your Answer:
Correct Answer: Grapefruit juice and also some other citrus juices should be avoided
Explanation:The cytochrome P450 enzyme system, responsible for metabolizing SSRIs and certain cholesterol-lowering medications, can be inhibited by consuming grapefruit juice and other juices like lime juice. Therefore, patients taking SSRI antidepressants should avoid these juices.
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This question is part of the following fields:
- Psychopharmacology
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Question 62
Incorrect
-
Who is the originator of the term 'cheese effect' in reference to the negative effects associated with MAOI antidepressants?
Your Answer:
Correct Answer: Blackwell
Explanation:A Historical Note on the Development of Zimelidine, the First Selective Serotonin Reuptake Inhibitor
In 1960s, evidence began to emerge suggesting a significant role of serotonin in depression. This led to the development of zimelidine, the first selective serotonin reuptake inhibitor (SSRI). Zimelidine was derived from pheniramine and was marketed in Europe in 1982. However, it was removed from the market in 1983 due to severe side effects such as hypersensitivity reactions and Guillain-Barre syndrome.
Despite its short-lived availability, zimelidine paved the way for the development of other SSRIs such as fluoxetine, which was approved by the FDA in 1987 and launched in the US market in 1988 under the trade name Prozac. The development of SSRIs revolutionized the treatment of depression and other mood disorders, providing a safer and more effective alternative to earlier antidepressants such as the tricyclics and MAO inhibitors.
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This question is part of the following fields:
- Psychopharmacology
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Question 63
Incorrect
-
Which of the following does the statement I saw a man shut his car door today and instantly knew this was a sign that I had to kill the queen exemplify?
Your Answer:
Correct Answer: Delusional perception
Explanation:Types of Delusions
Delusions come in many different forms. It is important to familiarize oneself with these types as they may be tested in an exam. Some of the most common types of delusions include:
– Folie a deux: a shared delusion between two or more people
– Grandiose: belief that one has special powers, beliefs, of purpose
– Hypochondriacal: belief that something is physically wrong with the patient
– Ekbom’s syndrome: belief that one has been infested with insects
– Othello syndrome: belief that a sexual partner is cheating on them
– Capgras delusion: belief that a person close to them has been replaced by a double
– Fregoli delusion: patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
– Syndrome of subjective doubles: belief that doubles of him/her exist
– Lycanthropy: belief that one has been transformed into an animal
– De Clérambault’s syndrome: false belief that a person is in love with them
– Cotard’s syndrome/nihilistic delusions: belief that they are dead of do not exist
– Referential: belief that others/TV/radio are speaking directly to of about the patient
– Delusional perception: belief that a normal percept (product of perception) has a special meaning
– Pseudocyesis: a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.Remembering these types of delusions can be helpful in understanding and diagnosing patients with delusional disorders.
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This question is part of the following fields:
- Classification And Assessment
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Question 64
Incorrect
-
Which of the following eosinophilic inclusion bodies are observed as a neuropathological discovery in individuals with Alzheimer's disease?
Your Answer:
Correct Answer: Hirano bodies
Explanation:Hirano bodies, Pick bodies, Lewy bodies, Negri bodies, and Barr bodies are all types of inclusion bodies that can be seen in various cells. Hirano bodies are rod-shaped structures found in the cytoplasm of neurons, composed of actin and other proteins. They are commonly seen in the hippocampus, along with granulovacuolar degeneration, which may represent lysosomal accumulations within neuronal cytoplasm. The clinical significance of these microscopic features is not yet fully understood. Pick bodies are masses of cytoskeletal elements seen in Pick’s disease, while Lewy bodies are abnormal protein aggregates that develop in nerve cells in Lewy body disease. Negri bodies are inclusion bodies seen in rabies, and Barr bodies are inactive X chromosomes in a female somatic cell.
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This question is part of the following fields:
- Neurosciences
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Question 65
Incorrect
-
Which of the following findings would provide the strongest evidence for a diagnosis of lithium toxicity in a man who has just started taking lithium and is reporting feeling unwell during a clinic visit?
Your Answer:
Correct Answer: Ataxia
Explanation:Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 66
Incorrect
-
What is a characteristic of the alcohol dependency syndrome according to the guidelines in ICD-10?
Your Answer:
Correct Answer: Salience
Explanation:The alcohol dependence syndrome, as defined in ICD-10, includes salience (of primacy) as a key feature. This refers to a state where obtaining of consuming alcohol becomes more important than previously significant aspects of a person’s life, such as family, relationships, of employment. Increased tolerance is also a part of this syndrome. However, narrowing of repertoire and relief drinking are not included in the ICD-10 definition. It is important to note that binge drinking is not considered a feature of the alcohol dependence syndrome.
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This question is part of the following fields:
- Classification And Assessment
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Question 67
Incorrect
-
Erikson's developmental model proposes that individuals face distinct challenges at various stages of their lives. At one of these stages, individuals learn the significance of accomplishments in social relationships beyond their family and the importance of achievements in their professional and academic pursuits. What is the name of this stage?
Your Answer:
Correct Answer: Industry vs. inferiority
Explanation:The stage of industry vs. inferiority occurs between the ages of 6 and 12, during which the child learns the importance of succeeding in school and building relationships outside of the family. Autonomy vs. doubt pertains to the stage of 1-2 years old, where the child learns self-discipline, self-assurance, and social norms. Initiative vs. guilt refers to the period of 3-5 years old, when the child forms a sense of self-identity. Intimacy vs. isolation is the stage where an individual develops a sense of commitment to others. Trust vs. mistrust is the stage where a sense of safety and security is established, typically occurring during the first year of life.
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This question is part of the following fields:
- Psychological Development
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Question 68
Incorrect
-
From which structure does the mesolimbic pathway project to the nucleus accumbens?
Your Answer:
Correct Answer: Midbrain
Explanation:Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.
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This question is part of the following fields:
- Neurosciences
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Question 69
Incorrect
-
What is the definition of transcription?
Your Answer:
Correct Answer: The process where messenger RNA is produced from DNA
Explanation:Genomics: Understanding DNA, RNA, Transcription, and Translation
Deoxyribonucleic acid (DNA) is a molecule composed of two chains that coil around each other to form a double helix. DNA is organised into chromosomes, and each chromosome is made up of DNA coiled around proteins called histones. RNA, on the other hand, is made from a long chain of nucleotide units and is usually single-stranded. RNA is transcribed from DNA by enzymes called RNA polymerases and is central to protein synthesis.
Transcription is the synthesis of RNA from a DNA template, and it consists of three main steps: initiation, elongation, and termination. RNA polymerase binds at a sequence of DNA called the promoter, and the transcriptome is the collection of RNA molecules that results from transcription. Translation, on the other hand, refers to the synthesis of polypeptides (proteins) from mRNA. Translation takes place on ribosomes in the cell cytoplasm, where mRNA is read and translated into the string of amino acid chains that make up the synthesized protein.
The process of translation involves messenger RNA (mRNA), transfer RNA (tRNA), and ribosomal RNA (rRNA). Transfer RNAs, of tRNAs, connect mRNA codons to the amino acids they encode, while ribosomes are the structures where polypeptides (proteins) are built. Like transcription, translation also consists of three stages: initiation, elongation, and termination. In initiation, the ribosome assembles around the mRNA to be read and the first tRNA carrying the amino acid methionine. In elongation, the amino acid chain gets longer, and in termination, the finished polypeptide chain is released.
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This question is part of the following fields:
- Genetics
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Question 70
Incorrect
-
Which statement accurately describes the half-life of a drug?
Your Answer:
Correct Answer: In Zero order reactions the half-life decreases as the concentration falls
Explanation:In contrast to first order reactions, drugs that exhibit zero order kinetics do not have a fixed half-life, as the rate of drug elimination remains constant regardless of the drug concentration in the plasma. The relationship between time and plasma concentration in zero order kinetics is linear, whereas in first order reactions, the half-life remains constant.
The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.
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This question is part of the following fields:
- Psychopharmacology
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Question 71
Incorrect
-
What is the most frequently occurring viable trisomy?
Your Answer:
Correct Answer: Trisomy 21
Explanation:Aneuploidy: Abnormal Chromosome Numbers
Aneuploidy refers to the presence of an abnormal number of chromosomes, which can result from errors during meiosis. Typically, human cells have 23 pairs of chromosomes, but aneuploidy can lead to extra of missing chromosomes. Trisomies, which involve the presence of an additional chromosome, are the most common aneuploidies in humans. However, most trisomies are not compatible with life, and only trisomy 21 (Down’s syndrome), trisomy 18 (Edwards syndrome), and trisomy 13 (Patau syndrome) survive to birth. Aneuploidy can result in imbalances in gene expression, which can lead to a range of symptoms and developmental issues.
Compared to autosomal trisomies, humans are more able to tolerate extra sex chromosomes. Klinefelter’s syndrome, which involves the presence of an extra X chromosome, is the most common sex chromosome aneuploidy. Individuals with Klinefelter’s and XYY often remain undiagnosed, but they may experience reduced sexual development and fertility. Monosomies, which involve the loss of a chromosome, are rare in humans. The only viable human monosomy involves the X chromosome and results in Turner’s syndrome. Turner’s females display a wide range of symptoms, including infertility and impaired sexual development.
The frequency and severity of aneuploidies vary widely. Down’s syndrome is the most common viable autosomal trisomy, affecting 1 in 800 births. Klinefelter’s syndrome affects 1-2 in 1000 male births, while XYY syndrome affects 1 in 1000 male births and Triple X syndrome affects 1 in 1000 births. Turner syndrome is less common, affecting 1 in 5000 female births. Edwards syndrome and Patau syndrome are rare, affecting 1 in 6000 and 1 in 10,000 births, respectively. Understanding the genetic basis and consequences of aneuploidy is important for diagnosis, treatment, and genetic counseling.
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This question is part of the following fields:
- Genetics
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Question 72
Incorrect
-
What factor increases the risk of developing SIADH?
Your Answer:
Correct Answer: Being female
Explanation:Hyponatremia in Psychiatric Patients
Hyponatremia, of low serum sodium, can occur in psychiatric patients due to the disorder itself, its treatment, of other medical conditions. Symptoms include nausea, confusion, seizures, and muscular cramps. Drug-induced hyponatremia is known as the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), which results from excessive secretion of ADH and fluid overload. Diagnosis is based on clinically euvolaemic state with low serum sodium and osmolality, raised urine sodium and osmolality. SSRIs, SNRIs, and tricyclics are the most common drugs that can cause SIADH. Risk factors for SIADH include starting a new drug, and treatment usually involves fluid restriction and sometimes demeclocycline.
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This question is part of the following fields:
- Psychopharmacology
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Question 73
Incorrect
-
What medication belongs to the class of SNRIs?
Your Answer:
Correct Answer: Venlafaxine
Explanation:Some significant SNRIs (Serotonin Noradrenaline reuptake inhibitors) are Venlafaxine and Duloxetine.
Mechanisms of Action of Different Drugs
Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.
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This question is part of the following fields:
- Psychopharmacology
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Question 74
Incorrect
-
Which of the following stages is not included in Bowlby's four stages of attachment?
Your Answer:
Correct Answer: Operational attachment
Explanation:Attachment Theory and Harlow’s Monkeys
Attachment theory, developed by John Bowlby, suggests that children have an innate tendency to form relationships with people around them to increase their chance of survival. This attachment is different from bonding, which concerns the mother’s feelings for her infant. Children typically single out a primary caregiver, referred to as the principle attachment figure, from about 1-3 months. The quality of a person’s early attachments is associated with their adult behavior, with poor attachments leading to withdrawn individuals who struggle to form relationships and good attachments leading to socially competent adults who can form healthy relationships.
Bowlby’s attachment model has four stages: preattachment, attachment in the making, clear-cut attachment, and formation of reciprocal attachment. The time from 6 months to 36 months is known as the critical period, during which a child is most vulnerable to interruptions in its attachment. Attachments are divided into secure and insecure types, with insecure types further divided into avoidant and ambivalent types.
Harlow’s experiment with young rhesus monkeys demonstrated the importance of the need for closeness over food. The experiment involved giving the monkeys a choice between two different mothers, one made of soft terry cloth but provided no food and the other made of wire but provided food from an attached baby bottle. The baby monkeys spent significantly more time with their cloth mother than with their wire mother, showing the importance of attachment and closeness in early development.
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This question is part of the following fields:
- Psychological Development
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Question 75
Incorrect
-
The rate of elimination of a drug that exhibits first order kinetics is characterized by what property?
Your Answer:
Correct Answer: Is proportional to its concentration with a linear relationship
Explanation:Many people confuse zero and first order kinetics, but it’s important to remember that zero order is non-linear while first order is linear. The linearity of first order kinetics refers to proportionality. The graphs used to illustrate this concept can be misleading, so it’s crucial to have a clear understanding of the difference between the two.
The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.
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This question is part of the following fields:
- Psychopharmacology
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Question 76
Incorrect
-
What type of memory is semantic memory responsible for?
Your Answer:
Correct Answer: Language and knowledge
Explanation:Memory Forms
Memory is the ability to store, retain, and retrieve information. There are different forms of memory, including sensory memory, short-term/working memory, and long-term memory.
Sensory memory is the capacity for briefly retaining the large amounts of information that people encounter daily. It includes echoic memory (gathered through auditory stimuli), iconic memory (gathered through sight), and haptic memory (acquired through touch).
Short-term memory is the ability to keep a small amount of information available for a short period of time. Atkinson and Shiffrin’s multistore model (1968) suggests the existence of a short-term storehouse with limited capacity. Baddeley and Hitch (1974) further developed the concept of short-term memory, which eventually became known as Baddeley’s multi-storehouse model (2000). This model includes the central executive, visuospatial sketchpad, phonological buffer/loop, and episodic buffer.
Long-term memory includes declarative (of explicit) memories, which can be consciously retrieved, and nondeclarative (of implicit) memories, which cannot. Declarative memory includes episodic memory (stores personal experiences) and semantic memory (stores information about facts and concepts). Non-declarative memory includes procedural memory (recalls motor and executive skills), associative memory (storage and retrieval of information through association with other information), and non-associative memory (refers to newly learned behavior through repeated exposure to an isolated stimulus).
Overall, memory is a complex and essential cognitive function that plays a crucial role in learning, reasoning, and understanding.
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This question is part of the following fields:
- Social Psychology
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Question 77
Incorrect
-
Which neo-Freudian theorist believed that the primary motivator in personality is the pursuit of superiority?
Your Answer:
Correct Answer: Alfred Adler
Explanation:Neo-Freudians were therapists who developed their own theories while still retaining core Freudian components. Some important neo-Freudians include Alfred Adler, Carl Jung, Erik Erickson, Harry Stack Sullivan, Wilfred Bion, John Bowlby, Anna Freud, Otto Kernberg, Margaret Mahler, and Donald Winnicott. Each of these individuals contributed unique ideas to the field of psychology. For example, Carl Jung introduced the concept of the persona and differentiated between the personal and collective unconscious, while Erik Erickson is known for his stages of psychosocial development. Margaret Mahler developed theories on child development, including the three main phases of autistic, symbiotic, and separation-individuation. Donald Winnicott introduced the concept of the transitional object and the good enough mother. Overall, neo-Freudians expanded upon Freud’s ideas and helped to shape modern psychotherapy.
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This question is part of the following fields:
- Social Psychology
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Question 78
Incorrect
-
What is a true statement about migraines?
Your Answer:
Correct Answer: They can be precipitated by stress
Explanation:Migraine
Migraine is a common condition that affects 5-10% of the population, with a higher prevalence in women than men (2-3:1). It typically starts in childhood of adolescence and has a strong familial association, with 2/3 of cases reporting a family history of migraine.
The most prominent symptom of migraine is headache, which is usually unilateral but can occur on both sides. Other symptoms include anorexia, nausea and vomiting, photophobia, and intolerance of noise.
In about 1/3 of cases, migraines are preceded by a visual aura (known as classic migraine). The most common form of visual aura is the ‘fortification spectra’ (semicircle of zigzag lights), but other disturbances such as micropsia, macropsia, zoom vision, mosaic vision, scotomas, and even hallucinations can occur.
Basilar migraines are a subtype of migraine where headache and aura are accompanied by difficulty speaking, vertigo, ringing in ears, of other brainstem-related symptoms, but not motor weakness.
Migraine can be triggered by various factors, including alcohol, cheese, chocolate, skipping meals, missing sleep, and oral contraceptives. Stress is also a common precipitant of migraine.
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This question is part of the following fields:
- Classification And Assessment
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Question 79
Incorrect
-
Which nuclei in the hypothalamus are responsible for the production and release of dopamine that is transported to the pituitary gland through the infundibulum?
Your Answer:
Correct Answer: Arcuate
Explanation:Functions of the Hypothalamus
The hypothalamus is a vital part of the brain that plays a crucial role in regulating various bodily functions. It receives and integrates sensory information about the internal environment and directs actions to control internal homeostasis. The hypothalamus contains several nuclei and fiber tracts, each with specific functions.
The suprachiasmatic nucleus (SCN) is responsible for regulating circadian rhythms. Neurons in the SCN have an intrinsic rhythm of discharge activity and receive input from the retina. The SCN is considered the body’s master clock, but it has multiple connections with other hypothalamic nuclei.
Body temperature control is mainly under the control of the preoptic, anterior, and posterior nuclei, which have temperature-sensitive neurons. As the temperature goes above 37ºC, warm-sensitive neurons are activated, triggering parasympathetic activity to promote heat loss. As the temperature goes below 37ºC, cold-sensitive neurons are activated, triggering sympathetic activity to promote conservation of heat.
The hypothalamus also plays a role in regulating prolactin secretion. Dopamine is tonically secreted by dopaminergic neurons that project from the arcuate nucleus of the hypothalamus into the anterior pituitary gland via the tuberoinfundibular pathway. The dopamine that is released acts on lactotrophic cells through D2-receptors, inhibiting prolactin synthesis. In the absence of pregnancy of lactation, prolactin is constitutively inhibited by dopamine. Dopamine antagonists result in hyperprolactinemia, while dopamine agonists inhibit prolactin secretion.
In summary, the hypothalamus is a complex structure that regulates various bodily functions, including circadian rhythms, body temperature, and prolactin secretion. Dysfunction of the hypothalamus can lead to various disorders, such as sleep-rhythm disorder, diabetes insipidus, hyperprolactinemia, and obesity.
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This question is part of the following fields:
- Neurosciences
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Question 80
Incorrect
-
What substance acts as an antagonist for GABA-A?
Your Answer:
Correct Answer: Flumazenil
Explanation:Flumazenil acts as an antagonist for GABA-A receptors and is known to reverse the effects of benzodiazepines. While there is some speculation that it may also have an effect on alcohol, this has not been definitively proven.
Mechanisms of Action of Different Drugs
Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.
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This question is part of the following fields:
- Psychopharmacology
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Question 81
Incorrect
-
A 65-year-old individual on lithium treatment experiences a fine tremor that is affecting their handwriting and causing embarrassment. Despite having normal lithium levels, what is the most effective solution to alleviate this issue?
Your Answer:
Correct Answer: Propranolol
Explanation:Lithium-induced tremor is a prevalent issue that can be resolved by discontinuing the medication. Propranolol is the most effective treatment option based on available evidence, while levodopa and anticholinergic agents have not been shown to be effective.
Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 82
Incorrect
-
You are on call for a general medical ward and are asked to evaluate a 45-year-old woman who has been experiencing intermittent confusion and aggression for the past three days. She recently recovered from a severe respiratory infection but has been experiencing 20-minute periods of lucidity and confusion, preceded by abdominal discomfort. There is no history of substance abuse of alcohol dependence, and all blood and urine tests have come back negative. A CT scan of her brain is normal, and she has not been taking her prescribed medication during her hospital stay. What is the most likely diagnosis?
Your Answer:
Correct Answer: Temporal lobe epilepsy
Explanation:Differential Diagnosis for a Patient with Temporal Lobe Epilepsy
Temporal lobe epilepsy, also known as complex partial seizures, is characterized by an aura of abdominal symptoms followed by altered consciousness and behavior. This episodic condition can occur rapidly. The presenting symptoms of this patient suggest an acute confusional state, ruling out antibiotic-induced psychosis, which is associated with ongoing antibiotic treatment. Delirium tremens, a severe form of alcohol withdrawal, is also unlikely. Early onset dementia cannot be associated with this presentation due to insufficient information. A differential diagnosis is necessary to determine the underlying cause of the patient’s symptoms.
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This question is part of the following fields:
- Diagnosis
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Question 83
Incorrect
-
A 65-year-old patient was recently diagnosed with diabetes and was prescribed medication. He now presents with weight loss and increased thirst.
Which investigation is most likely to help make the correct diagnosis of this weight loss and increased thirst?Your Answer:
Correct Answer: Fasting glucose
Explanation:The most likely diagnosis for this patient is type 2 diabetes mellitus. It is important to note that the patient is experiencing weight loss, which is more commonly associated with type 1 diabetes mellitus of new onset type 2 diabetes mellitus. A fasting glucose test can aid in making a diagnosis and provide insight into the cause of the patient’s symptoms.
While abnormalities related to dehydration may be observed in U&Es, this investigation alone would not be sufficient for a diagnosis. LFTs and FBC may be useful as routine blood tests, but they would not provide an explanation for the patient’s clinical presentation.
If the patient is taking lithium, measuring lithium levels could be helpful in identifying potential side effects such as increased thirst. However, lithium is more commonly associated with weight gain rather than weight loss, so it may not be relevant in this case.
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This question is part of the following fields:
- Assessment
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Question 84
Incorrect
-
What is the neurotransmitter that encourages sleep?
Your Answer:
Correct Answer: Acetylcholine
Explanation:REM sleep is facilitated by the presence of acetylcholine (Ach), while dopamine, histamine, noradrenaline, and serotonin act as inhibitors of sleep.
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This question is part of the following fields:
- Neurosciences
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Question 85
Incorrect
-
What defense mechanism is being demonstrated by a woman who is usually introverted and avoids social situations, but now insists on going out with friends every weekend, drinking excessively, and participating in karaoke?
Your Answer:
Correct Answer: Reaction formation
Explanation:In this situation, it is more appropriate to use the defense mechanism of reaction formation instead of sublimation. Sublimation involves redirecting an impulse into a positive outlet, but since the individual in question has a negative behavior of heavy drinking, it would not be effective. On the other hand, reaction formation involves expressing the opposite of the true impulse, which would be more suitable. It is important to note that sublimation and reaction formation do have some similarities, with sublimation being a more advanced version of reaction formation.
Intermediate Mechanism: Rationalisation
Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.
Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.
Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.
Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.
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This question is part of the following fields:
- Classification And Assessment
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Question 86
Incorrect
-
Which movement disorder is most likely to exhibit rhythmic movements?
Your Answer:
Correct Answer: Tremor
Explanation:Movement Disorders: Key Features
Movement disorders refer to a range of conditions that affect voluntary muscle movements. These disorders can be caused by various factors, including neurological conditions, medication side effects, and metabolic imbalances. The following table outlines some of the key features of common movement disorders:
Akinesia: Absence of loss of control of voluntary muscle movements, often seen in severe Parkinson’s disease.
Bradykinesia: Slowness of voluntary movement, a core symptom of Parkinson’s disease.
Akathisia: Subjective feeling of inner restlessness, often caused by antipsychotic medication use.
Athetosis: Continuous stream of slow, flowing, writhing involuntary movements, often seen in cerebral palsy, stroke, and Huntington’s disease.
Chorea: Brief, quasi-purposeful, irregular contractions that appear to flow from one muscle to the next, often seen in Huntington’s disease and Wilson’s disease.
Dystonia: Involuntary sustained of intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures, of both.
Dyskinesia: General term referring to problems with voluntary movements and the presence of involuntary movements, often drug-induced.
Myoclonus: A sequence of repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction of relaxation of one of more muscles.
Parkinsonism: Syndrome characterized by tremor, rigidity, and bradykinesia.
Tic: Sudden, repetitive, non-rhythmic, stereotyped motor movement of vocalization involving discrete muscle groups, often seen in Tourette’s syndrome.
Tremor: Involuntary, rhythmic, alternating movement of one of more body parts, often seen in essential tremor, Parkinson’s disease, and alcohol withdrawal.
Hemiballismus: Repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs, often seen in stroke and traumatic brain injury.
Stereotypies: Repetitive, simple movements that can be voluntarily suppressed, often seen in autism and intellectual disability.
It is important to consider the underlying conditions and factors that may contribute to movement disorders in order to properly diagnose and treat these conditions.
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This question is part of the following fields:
- Classification And Assessment
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Question 87
Incorrect
-
What is the causative agent of progressive multifocal leukoencephalopathy (PML), a common opportunistic CNS infection seen in individuals with AIDS?
Your Answer:
Correct Answer: John Cunningham virus (JCV)
Explanation:JCV is the cause of progressive multifocal leukoencephalopathy (PML) and typically affects individuals with weakened immune systems. Cryptococcus is a fungus that can lead to meningitis and meningoencephalitis in those with HIV/AIDS. CMV infection can be extremely dangerous for those who are immunocompromised. EBV is responsible for infectious mononucleosis, also known as glandular fever. Herpes simplex virus has two variations, HSV-1 and HSV-2, which can cause oral lesions (commonly known as cold sores) of genital lesions, respectively.
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This question is part of the following fields:
- Neurosciences
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Question 88
Incorrect
-
As an examining physician, have you ever encountered a situation where you can easily move a patient's arm upwards with minimal pressure, despite their attempts to resist? And once you stop applying pressure, the arm returns to its original position? If so, what is this sign called?
Your Answer:
Correct Answer: Mitgehen
Explanation:Mitgehen is a type of extreme cooperation that is observed in catatonia, where the patient moves their body in the direction of even the slightest pressure. It is crucial that the patient has been instructed to resist manipulation. This phenomenon is also referred to as the ‘angle poise lamp sign’ and is a form of automatic obedience. Catalepsy is another sign seen in catatonia, where patients maintain unusual postures for extended periods of time. In contrast, cataplexy is a sudden loss of muscle tone that leads to collapse and is commonly observed in narcolepsy. Gegenhalten is an involuntary resistance to passive movements. Mitmachen is a milder form of automatic obedience, where the patient’s body can be moved into any position without resistance when instructed to resist manipulation. Mitmachen is less severe than mitgehen, as the pressure required to elicit movements in mitgehen is very minimal.
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This question is part of the following fields:
- Descriptive Psychopathology
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Question 89
Incorrect
-
Which attitude scale involves a group of evaluators who rate each statement to determine its level of positivity towards a particular concept?
Your Answer:
Correct Answer: Thurstone scale
Explanation:Attitude scales are used to measure a person’s feelings and thoughts towards something. There are several types of attitude scales, including the Thurstone scale, Likert scale, semantic differential scale, and Gutman scale. The Thurstone scale involves creating a list of statements and having judges score them based on their negativity of positivity towards an issue. Respondents then indicate whether they agree of disagree with each statement. The Likert scale asks respondents to indicate their degree of agreement of disagreement with a series of statements using a five-point scale. The semantic differential scale presents pairs of opposite adjectives and asks respondents to rate their position on a five- of seven-point scale. The Gutman scale involves a list of statements that can be ordered hierarchically, with each statement having a corresponding weight. Respondents’ scores on the scale indicate the number of statements they agree with.
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This question is part of the following fields:
- Classification And Assessment
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Question 90
Incorrect
-
Which first-generation antipsychotic is utilized as an antiemetic in end-of-life care?
Your Answer:
Correct Answer: Chlorpromazine
Explanation:Antiemetic Properties of Antipsychotics
Antipsychotics are commonly used in palliative care to prevent nausea and vomiting. Chlorpromazine and haloperidol are two antipsychotics that have been found to be effective antiemetics. Chlorpromazine works by blocking histamine receptors, while haloperidol blocks dopamine receptors in the chemoreceptor trigger zone (CTZ), which influences the vomiting center. Promazine is also a potent histamine antagonist but is not commonly used as an antiemetic. However, both chlorpromazine and promazine have sedative effects.
Pimozide, on the other hand, has low affinity for histamine receptors, and pericyazine demonstrates moderate affinity. Flupenthixol is not used as an antiemetic. Overall, antipsychotics have proven to be effective in preventing nausea and vomiting in palliative care, with different mechanisms of action depending on the specific drug.
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This question is part of the following fields:
- Psychopharmacology
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Question 91
Incorrect
-
You encounter a 45-year-old man with a history of mild cognitive impairment and recurrent episodes of major depressive disorder. He was admitted to the hospital under section 3 of the Mental Health Act two months ago due to aggressive behaviour.
He reports feeling tired, sad, and lacking motivation to participate in any activities on the ward. He also reports difficulty getting out of bed in the morning. Despite being eligible for section 17 leave, he has refused to take advantage of it for the past two and a half months and spends all his time in his room.
He is currently taking fluoxetine 20 mg and PRN lorazepam for agitation. He has no known physical health issues. Your consultant has requested that you perform a blood test on him before considering adjusting his medication.
What is the most relevant blood test to request in this case?Your Answer:
Correct Answer: Vitamin D levels
Explanation:The most appropriate test to perform for this patient, who is exhibiting symptoms indicative of vitamin D deficiency due to insufficient exposure to sunlight, is a vitamin D level test. It is important to also check corrected calcium and PTH levels, as vitamin D is involved in calcium metabolism. Additionally, given the patient’s use of fluoxetine, U+Es may be checked to monitor for potential hyponatremia, while routine blood tests such as FBC, LFTS, and folic acid should also be considered.
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This question is part of the following fields:
- Assessment
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Question 92
Incorrect
-
A 60-year-old man presents to the emergency department with complaints of nausea and muscular weakness. He appears restless and mentions that he has recently been prescribed 'water pills'. His medical history reveals previous hospital visits for manic episodes. During the physical examination, you observe hypertonia. What is your suspected diagnosis?
Your Answer:
Correct Answer: Lithium toxicity
Explanation:The term ‘water pills / tablets’ is sometimes used by patients to describe diuretics. When taking thiazide diuretics, there is a risk of elevated lithium levels, which can lead to symptoms indicative of lithium toxicity.
Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 93
Incorrect
-
Who is credited with creating the term 'neurasthenia'?
Your Answer:
Correct Answer: Beard
Explanation:History of Psychiatric Terms
In the exams, it is important to be familiar with the individuals associated with certain psychiatric terms. For example, Kraepelin is associated with dementia praecox and manic depression, while Bleuler is associated with schizophrenia. Other terms and their associated individuals include Hebephrenia (Hecker), Catatonia (Kahlbaum), Schizoaffective (Kasanin), Neurasthenia (Beard), Unipolar and bipolar (Kleist), Hypnosis (Braid), Group dynamics (Lewin), Group psychotherapy (Moreno), Psychopathic inferiority (Koch), Psychiatry (Reil), and Institutional Neurosis (Barton).
It should be noted that there is some debate over the origins of certain terms. While Kraepelin is often credited with coining the term dementia praecox, some sources suggest that it was first used in its Latin form by Arnold Pick in 1891. The original term demence precoce was first used by Morel in 1852. Despite this, the College appears to favor the Kraepelin attribution.
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This question is part of the following fields:
- Social Psychology
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Question 94
Incorrect
-
A teenager who is a victim of a crime is more likely to receive assistance from a bystander if:
Your Answer:
Correct Answer: The bystander is male
Explanation:The Bystander Effect: Theory and Examples
The bystander effect, also known as the Genovese effect, suggests that the likelihood of someone helping in a situation is inversely related to the number of people present. This means that a person is more likely to help if there are fewer witnesses. The term Genovese effect comes from the case of Kitty Genovese, who was sexually assaulted and killed in front of a large apartment building. Despite 38 neighbors hearing her screams, no one called the police. However, the facts of this story have been largely shown to be inaccurate.
Bystanders are less likely to help if there are many other people present, if the perpetrator is present, if the costs of intervention are physical, and if the situation is perceived as dangerous. On the other hand, bystanders are more likely to help if they are male and if they know the person in need of help. Overall, the bystander effect has been shown to be a valid concept, as demonstrated by research studies.
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This question is part of the following fields:
- Social Psychology
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Question 95
Incorrect
-
What statement accurately describes the LUNSERS?
Your Answer:
Correct Answer: It includes 'red herring' items
Explanation:The LUNSERS is a self-administered rating scale consisting of 51 items used to detect side effects caused by antipsychotic medication. It comprises 41 established side effects of neuroleptics and 10 additional items that are not known to be side effects of such medication, such as hair loss and chilblains, to validate the results. The scale’s validity and reliability were assessed in a sample of 50 male and female patients with an average age of 46 years and 16 years of antipsychotic use, as well as a group of 50 healthy controls, with promising outcomes. Furthermore, the LUNSERS’ validity was compared to that of the UKU, which is the gold standard and takes approximately 60 minutes to complete.
In psychiatry, various questionnaires and interviews are used to assess different conditions and areas. It is important for candidates to know whether certain assessment tools are self-rated of require clinical assistance. The table provided by the college lists some of the commonly used assessment tools and indicates whether they are self-rated of clinician-rated. For example, the HAMD and MADRS are clinician-rated scales used to assess the severity of depression, while the GDS is a self-rated scale used to screen for depression in the elderly. The YMRS is a clinician-rated scale used to assess the severity of mania in patients with bipolar disorder, while the Y-BOCS is used to measure both the severity of OCD and the response to treatment. The GAF provides a single measure of global functioning, while the CGI requires the clinician to rate the severity of the patient’s illness at the time of assessment. The CAMDEX is a tool developed to assist in the early diagnosis and measurement of dementia in the elderly.
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This question is part of the following fields:
- Classification And Assessment
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Question 96
Incorrect
-
Which condition is commonly associated with the term La belle indifference?
Your Answer:
Correct Answer: Conversion disorder
Explanation:La belle indifference is a term of French origin that refers to a paradoxical lack of emotional distress in individuals who have a serious medical illness of symptoms related to a health condition. This phenomenon is often observed in cases of conversion (dissociative) disorder.
Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterised by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. Somatoform disorders are characterised by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterised by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. The former involves bodily symptoms that the individual finds distressing and to which excessive attention is directed, while the latter involves a disturbance in the person’s experience of the body manifested by the persistent desire to have a specific physical disability accompanied by persistent discomfort of intense feelings of inappropriateness concerning current non-disabled body configuration. Dissociative disorders, on the other hand, are characterised by involuntary disruption of discontinuity in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. The ICD-11 dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. Each disorder has its own set of essential features and diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 97
Incorrect
-
Which of the following is not an inhibitor of the Cytochrome P450 system?
Your Answer:
Correct Answer: Phenytoin
Explanation:Certain substances can either induce or inhibit the activity of enzymes responsible for metabolizing drugs in the body. Inducers include smoking, alcohol, barbiturates, carbamazepine, Phenytoin, and St John’s Wort, while inhibitors include chlorpromazine, SSRIs, and grapefruit juice.
The Cytochrome P450 system is a group of enzymes that metabolize drugs by altering their functional groups. The system is located in the liver and small intestine and is involved in drug interactions through enzyme induction of inhibition. Notable inducers include smoking, alcohol, and St John’s Wort, while notable inhibitors include grapefruit juice and some SSRIs. CYP2D6 is important due to genetic polymorphism, and CYP3A4 is the most abundant subfamily and is commonly involved in interactions. Grapefruit juice inhibits both CYP1A2 and CYP3A4, while tobacco smoking induces CYP1A2. The table summarizes the main substrates, inhibitors, and inducers for each CYP enzyme.
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This question is part of the following fields:
- Psychopharmacology
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Question 98
Incorrect
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A patient in their 60s taking an antipsychotic is found to have a QTc of 490ms. What would be the most appropriate alternative to their current antipsychotic medication?
Your Answer:
Correct Answer: Aripiprazole
Explanation:Amantadine and QTc Prolongation
Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.
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This question is part of the following fields:
- Psychopharmacology
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Question 99
Incorrect
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Which food should be consumed with caution by patients taking tranylcypromine?
Your Answer:
Correct Answer: Cheese
Explanation:MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions
First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).
MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.
The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.
Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.
Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).
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This question is part of the following fields:
- Psychopharmacology
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Question 100
Incorrect
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A researcher studying obesity in adolescents is interested in creating a medication that suppresses hunger. Which neuropeptide transmitter would be the target for developing an antagonist drug?
Your Answer:
Correct Answer: Neuropeptide Y
Explanation:Neuropeptide Y is a neuropeptide that stimulates appetite and is a target for developing antagonists in obesity research. Angiotensin is a peptide hormone involved in controlling blood pressure through vasoconstriction. Cholecystokinin has been linked to schizophrenia, eating disorders, movement disorders, anxiety, and panic attacks. Neurotensin is hypothesized to be involved in schizophrenia due to its co-existence with dopamine in some axon terminals. Substance P is primarily associated with pain perception.
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This question is part of the following fields:
- Neurological Examination
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Question 101
Incorrect
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What is the half-life of fluoxetine in the body?
Your Answer:
Correct Answer: 4-6 days
Explanation:Fluoxetine has the longest half life among the commonly used SSRIs, lasting four to six days. Its active metabolite, norfluoxetine, remains active for four to 16 days. This information is important when discontinuing of switching SSRIs.
For instance, if a patient is discontinuing an SSRI with a shorter half life, such as paroxetine, they may experience SSRI discontinuation syndrome. To avoid this, they can switch to fluoxetine before tapering off the antidepressant.
When cross-titrating from fluoxetine to another antidepressant, the longer half life means that the drug needs to be withdrawn and a longer period allowed for levels in the body to decrease. The recommended time to start a new antidepressant after withdrawing fluoxetine varies depending on the drug, such as waiting five to six weeks before starting an MAOI.
The incorrect answers are:
– Paroxetine has an elimination half life of 24 hours
– Sertraline has an elimination half life of 26 hours
– Escitalopram has an elimination half life of 30 hours
– Citalopram has an elimination half life of 33 hours. -
This question is part of the following fields:
- Psychopharmacology
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Question 102
Incorrect
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What is the most probable cause of negative consequences when consuming alcohol?
Your Answer:
Correct Answer: Possessing very active forms of alcohol dehydrogenase
Explanation:The accumulation of acetaldehyde in the bloodstream is responsible for the negative consequences of alcohol consumption, which can occur when alcohol dehydrogenase is active of aldehyde dehydrogenase is inactive.
Genetics and Alcoholism
Alcoholism tends to run in families, and several studies confirm that biological children of alcoholics are more likely to develop alcoholism even when adopted by parents without the condition. Monozygotic twins have a greater concordance rate for alcoholism than dizygotic twins. Heritability estimates range from 45 to 65 percent for both men and women. While genetic differences affect risk, there is no “gene for alcoholism,” and both environmental and social factors weigh heavily on the outcome.
The genes with the clearest contribution to the risk for alcoholism and alcohol consumption are alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2). The first step in ethanol metabolism is oxidation to acetaldehyde, by ADHs. The second step is metabolism of the acetaldehyde to acetate by ALDHs. Individuals carrying even a single copy of the ALDH2*504K display the “Asian flushing reaction” when they consume even small amounts of alcohol. There is one significant genetic polymorphism of the ALDH2 gene, resulting in allelic variants ALDH2*1 and ALDH2*2, which is virtually inactive. ALDH2*2 is present in about 50 percent of the Taiwanese, Han Chinese, and Japanese populations. It is extremely rare outside Asia. Nearly no individuals of European of African descent carry this allele. ALDH2*504K has repeatedly been demonstrated to have a protective effect against alcohol use disorders.
The three different class I gene loci, ADH1A (alpha), ADH1B (beta), and ADH1C (gamma) are situated close to each other in the region 4q2123. The alleles ADH1C*1 and ADH1B*2 code for fast metabolism of alcohol. The ADH1B*1 slow allele is very common among Caucasians, with approximately 95 percent having the homozygous ADH1B*1/1 genotype and 5 percent having the heterozygous ADH1B*1/2 genotype. The ADH1B*2 allele is the most common allele in Asian populations. In African populations, the ADH1B*1 allele is the most common.
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This question is part of the following fields:
- Genetics
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Question 103
Incorrect
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An HIV+ patient in their 60s attends clinic in view of ongoing depression. You note a number of cutaneous lesions in the form of purple-red macules on their face and neck. These are also apparent on the mucous membranes. Which of the following would you most suspect?:
Your Answer:
Correct Answer: Kaposi's sarcoma
Explanation:Kaposi’s sarcoma is a type of tumor that is caused by human herpesvirus 8. When it is associated with AIDS, it typically appears as red to purple-red macules on the skin that quickly progress to papules, nodules, and plaques. These lesions tend to occur on the head, back, neck, trunk, and mucous membranes, and can also be found in the lymph nodes, stomach, intestines, and lungs in more advanced cases. Individuals with severe mental illness are at a higher risk of contracting and transmitting HIV, and are more likely to have HIV infection compared to the general population. Therefore, it is important to have a basic understanding of the symptoms of this condition.
HIV and Mental Health: Understanding the Relationship and Treatment Options
Human immunodeficiency virus (HIV) is a blood-borne virus that causes cellular immune deficiency, resulting in a decrease in the number of CD4+ T-cells. People with severe mental illness are at increased risk of contracting and transmitting HIV, and the prevalence of HIV infection among them is higher than in the general population. Antiretroviral drugs are used to manage HIV, but they are not curative.
Depression is the most common mental disorder in the HIV population, and it can result from HIV of the psycho-social consequences of having the condition. HIV-associated neurocognitive disorder (HAND) is the umbrella term for the spectrum of neurocognitive impairment induced by HIV, ranging from mild impairment through to dementia. Poor episodic memory is the most frequently reported cognitive difficulty in HIV-positive individuals.
Treatment options for mental health issues in people with HIV include atypical antipsychotics for psychosis, SSRIs for depression and anxiety, valproate for bipolar disorder, and antiretroviral therapy for HAND. It is important to avoid benzodiazepines for delirium and MAOIs for depression. Understanding the relationship between HIV and mental health and providing appropriate treatment options can improve the quality of life for people living with HIV.
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This question is part of the following fields:
- Psychopharmacology
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Question 104
Incorrect
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Your elderly client informs you that she had a sudden realization that she was a member of the senior center's board. This awareness came out of nowhere.
Is this an instance of:Your Answer:
Correct Answer: Autochthonous delusion
Explanation:Delusions that originate within the mind without any external influence are known as autochthonous. This term, derived from the Greek word for from the soil, emphasizes that the idea is self-generated rather than being triggered by a sensory experience of other external factor.
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This question is part of the following fields:
- History And Mental State
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Question 105
Incorrect
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Which Piagetian stage is accurately paired with the corresponding developmental period?
Your Answer:
Correct Answer: Preoperational - 2-7 years
Explanation:Piaget’s Stages of Development and Key Concepts
Piaget developed four stages of development that describe how children think and acquire knowledge. The first stage is the Sensorimotor stage, which occurs from birth to 18-24 months. In this stage, infants learn through sensory observation and gain control of their motor functions through activity, exploration, and manipulation of the environment.
The second stage is the Preoperational stage, which occurs from 2 to 7 years. During this stage, children use symbols and language more extensively, but they are unable to think logically of deductively. They also use a type of magical thinking and animistic thinking.
The third stage is the Concrete Operational stage, which occurs from 7 to 11 years. In this stage, egocentric thought is replaced by operational thought, which involves dealing with a wide array of information outside the child. Children in this stage begin to use limited logical thought and can serialise, order, and group things into classes on the basis of common characteristics.
The fourth and final stage is the Formal Operations stage, which occurs from 11 through the end of adolescence. This stage is characterized by the ability to think abstractly, to reason deductively, to define concepts, and also by the emergence of skills for dealing with permutations and combinations.
Piaget also developed key concepts, including schema, assimilation, and accommodation. A schema is a category of knowledge and the process of obtaining that knowledge. Assimilation is the process of taking new information into an existing schema, while accommodation involves altering a schema in view of additional information.
Overall, Piaget’s stages of development and key concepts provide a framework for understanding how children learn and acquire knowledge.
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This question is part of the following fields:
- Psychological Development
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Question 106
Incorrect
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What is a true statement about antidepressant medications that are not taken orally?
Your Answer:
Correct Answer: Compared to orally administered antidepressants, those given intravenously tend to require lower doses
Explanation:Intravenous formulations bypass the initial metabolism in the liver, resulting in increased concentrations of the drug in the bloodstream.
Alternative Routes of Administration for Antidepressants
While most antidepressants are taken orally, there are a few alternative routes of administration available. However, it is important to note that these non-oral preparations should only be used when absolutely necessary, as they may not have a UK licence.
One effective alternative route is sublingual administration of fluoxetine liquid. Buccal administration of selegiline is also available. Crushed amitriptyline has been shown to be effective when administered via this route.
Intravenous administration is another option, with several antidepressants available in IV preparations, including citalopram, escitalopram, mirtazapine, amitriptyline, clomipramine, and allopregnanolone (which is licensed in the US for postpartum depression). Ketamine has also been shown to be effective when administered intravenously.
Intramuscular administration of flupentixol has been shown to have a mood elevating effect, but amitriptyline was discontinued as an IM preparation due to the high volumes required.
Transdermal administration of selegiline is available, and suppositories containing amitriptyline, clomipramine, imipramine, and trazodone have been manufactured by pharmacies, although there is no clear data on their effectiveness. Sertraline tablets and doxepin capsules have also been given rectally.
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This question is part of the following fields:
- Psychopharmacology
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Question 107
Incorrect
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Who is recognized as the originator of trait theory?
Your Answer:
Correct Answer: Allport
Explanation:Trait Theory: Understanding Personality Traits
Trait theory is a psychological approach that seeks to understand personality by identifying and categorizing specific traits. The theory was first introduced by Gordon Allport, who classified personality traits into three levels.
At the highest level, we have cardinal traits. These are traits that are so pervasive that they dominate a person’s behavior and activities. Only a few people possess cardinal traits, but for those who do, these traits are the ruling force of their personality. Cardinal traits are usually evident to most people who know the individual.
The second level of traits is central traits. These are easily detected characteristics within a person, traits that all people have a certain number of, usually around five to ten on average. Central traits are the building blocks of personality and help to define a person’s overall character.
Finally, we have secondary traits. These are less evident and only manifest in select circumstances. They are not as important as central of cardinal traits, but they still play a role in shaping a person’s behavior and personality.
Overall, trait theory provides a useful framework for understanding personality and how it develops over time. By identifying and categorizing specific traits, psychologists can gain insights into why people behave the way they do and how they can change their behavior to achieve their goals.
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This question is part of the following fields:
- Social Psychology
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Question 108
Incorrect
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What type of delusion is considered a first rank symptom?
Your Answer:
Correct Answer: Delusional perception
Explanation:First Rank Symptoms: Their Significance in Identifying Schizophrenia
First rank symptoms were introduced by Kurt Schneider in 1938 as a practical tool for non-psychiatrists to identify schizophrenia. While they are highly suggestive of schizophrenia, they are not pathognomonic and can also be seen in affective and personality disorders. Additionally, there is no evidence to support their prognostic significance.
A systematic review in 2015 found that first rank symptoms differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% and a specificity of 94.1%. They also differentiated schizophrenia from other types of psychosis with a sensitivity of 58% and a specificity of 74.7%.
The first rank symptoms include running commentary, thought echo, voices heard arguing, thought insertion, thought withdrawal, thought broadcast, delusional perception, somatic passivity, made affect, and made volition. While they can be helpful in identifying schizophrenia, they should not be relied upon as the sole diagnostic criteria.
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This question is part of the following fields:
- Classification And Assessment
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Question 109
Incorrect
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The theorist who proposed the existence of the language acquisition device (LAD) in humans is:
Your Answer:
Correct Answer: Chomsky
Explanation:Chomsky is known for his nativist theory and introduction of the language acquisition device (LAD) in the 1960s. Empiricism theory is often attributed to Locke, while parsing was described by Saffran. Skinner is associated with behaviourism, and Werker studied how infants distinguish between phonemes.
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This question is part of the following fields:
- Advanced Psychological Processes And Treatments
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Question 110
Incorrect
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What is a true statement about dopamine receptors?
Your Answer:
Correct Answer: Activation of D1 receptors activates adenylyl cyclase
Explanation:Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.
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This question is part of the following fields:
- Neurosciences
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Question 111
Incorrect
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A person who struggles with reproducing intersecting pentagons on the MMSE at an older age is likely to experience difficulties with which of the following?
Your Answer:
Correct Answer: Non dominant parietal lobe
Explanation:The inability to accurately replicate intersecting pentagons may indicate a constructional apraxia, which is a symptom of non-dominant parietal lobe dysfunction.
Parietal Lobe Dysfunction: Types and Symptoms
The parietal lobe is a part of the brain that plays a crucial role in processing sensory information and integrating it with other cognitive functions. Dysfunction in this area can lead to various symptoms, depending on the location and extent of the damage.
Dominant parietal lobe dysfunction, often caused by a stroke, can result in Gerstmann’s syndrome, which includes finger agnosia, dyscalculia, dysgraphia, and right-left disorientation. Non-dominant parietal lobe dysfunction, on the other hand, can cause anosognosia, dressing apraxia, spatial neglect, and constructional apraxia.
Bilateral damage to the parieto-occipital lobes, a rare condition, can lead to Balint’s syndrome, which is characterized by oculomotor apraxia, optic ataxia, and simultanagnosia. These symptoms can affect a person’s ability to shift gaze, interact with objects, and perceive multiple objects at once.
In summary, parietal lobe dysfunction can manifest in various ways, and understanding the specific symptoms can help diagnose and treat the underlying condition.
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This question is part of the following fields:
- Neurosciences
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Question 112
Incorrect
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What is a correct statement about antipsychotic depots?
Your Answer:
Correct Answer: There is RCT evidence to suggest that Zuclopenthixol may be more effective in preventing relapses than other first-generation antipsychotic depots
Explanation:, coma, respiratory depression (rare)
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This question is part of the following fields:
- Psychopharmacology
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Question 113
Incorrect
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A 35-year-old man was at a concert when a firework exploded nearby. He was standing at the time and the force of the blast threw him to the ground. He suffered a broken arm and multiple cuts. Several people were killed and many others were injured.
After four months, he experiences nightmares about the incident, struggles to sleep, has avoided going to concerts since, and jumps at sudden sounds. He often finds himself unable to stop thinking about what happened.
What is the probable diagnosis?Your Answer:
Correct Answer: Post-traumatic stress disorder
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